Repaglinide - Metformin Combo Is Safe and Effective for Type 2’s
Patients who received repaglinide/metformin treatment had lower final HbA1c values than those who received nateglinide/metformin.

In an open-label, parallel-group, randomized, multicenter study, Dr. Philip Raskin, of the University of Texas, Southwestern Medical Center at Dallas, and colleagues examined the safety and efficacy of repaglinide versus nateglinide used in combination with metformin in 192 type 2 diabetes. At baseline, HbA1c levels ranged between 7% and 12% during treatment with a sulfonylurea, metformin, or low-dose Glucovance.

After a 4-week metformin run-in therapy period, repaglinide or nateglinide was added for 16 weeks. The team assessed glucose, insulin, and glucagon after a liquid test meal at baseline and at 16 weeks' follow-up.

Patients who received repaglinide/metformin treatment had lower final HbA1c values than those who received nateglinide/metformin (7.1% versus 7.5%, respectively). Reductions of HbA1c were significantly greater in the repaglinide/metformin group (-1.28%) than in the nateglinide/metformin group (-0.67%, p < 0.001).

Patients in the repaglinide/metformin group also had greater reductions in fasting plasma glucose (-38 mg/dL versus -21 mg/dL, respectively; p = 0.002).

Mean self-monitoring of blood glucose values were significantly lower in the repaglinide/metformin group before breakfast, lunch, and at 2:00 AM, according to the investigators. No significant differences in changes in the area under the curve of postprandial glucose, insulin, or glucagon peaks after a test meal were observed between the groups. Safety profiles were similar between the groups.

These findings, Dr. Raskin's group concludes, provide a "direct comparison that will obviate the need to draw comparisons between separate and potentially disparate clinical studies of the efficacy of the individual drugs." Diabetes Care 2003; 26:2063-2068.

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Did YOU KNOW:
Being overweight is a risk factor for dementia in women over age 70, according to a Swedish study. Because weight loss often accompanies dementia, the link between large body size and dementia has not been appreciated, Dr. Deborah Gustafson and associates explain in the July 14 issue of the Archives of Internal Medicine. The highest prevalence of overweight and obesity is observed among adults age 50 and higher, they note, while dementia is the fastest growing disease of late life. Therefore, they conclude, prevention of overweight and obesity, even in older age, should be a high priority in Western populations in order to prevent dementia. Arch Intern Med 2003;163:1524-1528

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