The oral anti-diabetic drug (OAD) repaglinide tablets can help improve glycaemic control - the amount of glucose in the blood - according to new research from Denmark.
The OAD, which is called Prandin in the United States, NovoNorm in Europe, and Gluconorm in Canada, can have a significant effect in the early release of insulin following meals if it is taken before each of the three main daily meals, according to Dr Ole Schmitz, professor and chief physician of the Department of Endocrinology at University Hospital in Aarhus, Denmark.
Writing in the February issue of Diabetes Care journal, Schmitz and his team said that compared to twice daily dosing, taking repaglinide tablets with the three main daily meals resulted in greater improvements in certain measures of glycaemic control.
"During the past decade, a large body of evidence has underscored the important role of the early-phase insulin release in controlling the level of post-prandial glycaemia, the surge in blood glucose following food consumption," Schmitz said. He added that prospective studies are under way to examine the benefits of post-prandial glucose control.
In the double blind, four-week study, 19 individuals with type 2 diabetes who were new to OAD therapy were randomly assigned to receive either a 0.25 mg dose of repaglinide before each of the three main meals, or a 0.5 mg repaglinide dose before breakfast and a 0.25 mg dose before the evening meal. Mealtime dosing was doubled after two weeks to a total daily dose of 1.5 mg in both groups. Both study treatment groups received the same total daily dose of repaglinide throughout the duration of the study.
For both treatment groups, repaglinide resulted in steeper initial rises in post-prandial insulin concentration compared with baseline. Because the three-times-daily dosing group also had a lunch dose, this group showed higher early-phase post-lunch insulin secretion compared to the group who received no dose at lunch.
Fasting and post-prandial glucose levels after each meal were lower in patients receiving three doses compared with those receiving two doses. Reductions in HbA1c were significantly greater with three repaglinide doses than with two, despite the relatively short treatment period. No serious adverse events or major hypoglycaemia (abnormally low blood glucose) episodes occurred in either group; minor adverse events were confined to mild hypoglycaemia.
"The findings reinforce the value of flexible mealtime dosing of repaglinide by clearly demonstrating a near-normalisation of glycaemic control," said Schmitz. "Repaglinide resulted in reductions not only in post-prandial glucose, but also in fasting glucose and HbA1c levels, all of which are associated with reducing the risk of late diabetic complications. However, it is important to stress that not even the most efficient medical intervention can diminish the critical need for lifestyle (diet and exercise) intervention," he said.
NovoNorm is made by the Novo Nordisk pharmaceutical group and can be taken on its own or in combination with metformin for individuals with type 2 diabetes whose hyperglycemia (abnormally high blood glucose) cannot be controlled by diet and exercise alone. NovoNorm was developed specifically for dosing at mealtime, to control post-prandial hyperglycemia.