Nateglinide Reduces
Both Post-and Interprandial Glucose
Levels
CGMS demonstrates nateglinide also
reduces interprandial blood glucose
as well as postprandal blood glucose.
Nateglinide therapy may lower interprandial
blood glucose levels in patients with
type 2 diabetes, in addition to the
known effect on postprandial blood glucose
levels, suggest the findings of a study
using continuous blood glucose monitoring.
Measurement of blood glucose levels
from the finger or forearm is often
painful and inconvenient for patient
with diabetes, making it difficult to
obtain 24-hour blood glucose profiles
for these patients. However, a new technology,
CGMS, (Medtronic MiniMed, Northridge,
CA) has been developed to provide continuous
blood glucose monitoring.
According to Heidemarie Abrahamian,
MD, of the City Hospital Vienna Lainz,
Austria, CGMS "can provide more
insight in the efficacy and safety of
new therapeutic agents." Dr. Abrahamian
and colleagues performed a study using
CGMS to evaluate the effects of the
new insulinotropic agent, nateglinide,
over a 24-hour period in patients with
type 2 diabetes. Nateglinide produces
a glucose-dependent, rapid and short
insulin release and has been previously
shown to effectively lower mealtime
blood glucose excursions.
Eighteen patients with type 2 diabetes
participated in the study (mean age,
60; 11 males; mean HbA1c, 8.4%), 7 on
diet only and 11 on metformin monotherapy.
Patients underwent 72-hour glucose monitoring
with CGMS while continuing their usual
diabetes therapy and eating a standardized
breakfast. Patients then started nateglinide
therapy at 120 mg 3 times a day before
meals. Three days after treatment, 72-hour
glucose monitoring was performed again.
According to the researchers, patients
showed a significant decrease in overall
blood glucose values after receiving
nateglinide therapy (131±21 vs.
172±34 mg/dL, P < .0004).
Nateglinide therapy reduced the number
of postprandial blood glucose values
above 140 mg/dL within 24 hours by 50%
(207 vs. 98, P < .001). In addition
to a significant decrease in postprandial
blood glucose levels, nateglinide also
produced a decrease in fasting blood
glucose (172±48 to 126±26
mg/dL, P < .0005). No severe hypoglycemic
episodes or other adverse events were
associated with the therapy.
The researchers note that a significant
decrease of interprandial glucose values
with nateglinide therapy has not been
previously demonstrated. "The significant
decrease of interprandial glucose levels,
besides the known effect on prandial
glucose excursions, was demonstrated
impressively by means of the CGMS, which
is an additional helpful tool in diabetes
care," they conclude. Diabetes
Technol Ther 2004 Feb;6:1:31-7.
===========================
FACT:
Aggressive lipid lowering with
statins is better than moderate
lowering, according to the results
of the Pravastatin or Atorvastatin
Evaluation and Infection Therapy–Thrombolysis
in Myocardial Infarction 22 (PROVE
IT–TIMI 22) trial published
in the April 8 issue of the New
England Journal of Medicine
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