Repaglinide, mogelijk een therapeutische aanwinst bij diabetes mellitus type 2

In about 25% of type 2 diabetes patients, good diabetes control is not attainable with oral blood-glucose lowering drugs. Furthermore, in many people with diabetes the disease deteriorates, despite the use of blood-glucose lowering medication, due to the decline of the pancreatic beta cells. The development of new drugs, such as repaglinide, is therefore important. Repaglinide is an insulin secretion enhancer with a different mechanism of action to the sulphonylureas, which means it does not continuously stimulate insulin secretion. The tablets should be taken with each meal. After oral ingestion repaglinide is resorbed quickly, with a half-life of between 30 minutes to an hour. In clinical trials repaglinide has been found to be equally effective as glibenclamide. Repaglinide has been found to be particularly effective in sulphonylurea-naïve patients. Skipping the meal plus tablet combination results in less frequent hypoglycaemic symptoms compared to glibenclamide. Repaglinide results in greater reductions in postprandial glucose levels than glibenclamide. It does not affect insulin resistance. Long-term data are lacking, both with regard to efficacy and side effects. Repaglinide deserves a place in the diabetes treatment of newly-diagnosed type 2 diabetes patients who are well-informed about their disease, as well as in patients with renal failure. It should also be considered for patients whose diabetes is poorly controlled on metformin monotherapy.