Meglitinides - Meglitinides for Diabetes

Meglitinides

Meglitinides
April 2008
Drug Digest

Non-sulfonylureal insulin secretagogues, also known as the "meglitinides," lower blood sugar levels by stimulating the release of insulin from the pancreas in response to glucose (from food). Insulin is required to move sugar from the bloodstream into the cells of the body where it can be used as energy. To work best, meglitinides should be taken immediately before a meal. The meglitinides may be used alone or in combination with metformin or a thiazolidinedione (such as Actos or Avandia).

Drugs in this Class
Nateglinide Tablets ( Starlix Tablets )
Repaglinide ( Prandin Tablets )

Summarizing the Evidence

* The drugs in this class are unique because they are relatively short-acting compared to other classes of drugs used to treat Type 2 diabetes. They are taken immediately before a meal to stimulate the pancreas to secrete insulin. The secreted insulin then helps move glucose (that was ingested from the meal) to the cells of the body to be used for energy. Because other drugs used to treat diabetes can cause low blood sugar episodes, meglitinides may be best used in patients who have a sporadic meal schedule or who do not eat regular, full meals in order to lower the incidence of low blood sugar episodes.

* There have been few, relatively small head-to-head trials comparing the efficacy of Prandin to Starlix in lowering blood sugars levels. The trials that have been published have demonstrated Starlix to have a quicker onset in lowering blood sugar levels after meals than Prandin; however, Prandin appears to have a more favorable, longer-lasting effect than Starlix. According to a small study published in 2004, Prandin appears to be more effective than Starlix in controlling diabetes as measured by a diabetic blood test called a "hemoglobin A1C" or "HbA1c" and as measured by fasting blood sugar levels after 16 weeks of therapy.

* In another small trial, published in 2003, the addition of Prandin to metformin decreased fasting blood sugar levels significantly more than the addition of Starlix to metformin therapy. However, larger, more conclusive studies are needed to confirm whether or not these results are valid.

* Both meglitinides have the same FDA-approved indications and can be used by themselves or in combination with either metformin or a thiazolidinedione (such as Actos or Avandia).

* Both meglitinides appears to have similar adverse events and potential drug interaction profiles. However, Prandin appears to be associated with more minor hypoglycemia (low blood sugar episodes) than Starlix.

* The choice of which meglitinide to use will generally depend on your doctor's preference and/or your prescription benefits formulary.

Dosing and Administration

* Both Prandin and Starlix should be taken 1-30 minutes before meals. Prandin may be taken 2-4 times a day and should have the dose slowly increased over time while Starlix is typically taken 3 times a day with each main meal and rarely needs dose adjustment. To reduce the risk for low blood sugar, Prandin and Starlix are to be taken prior to meals, and those who skip meals should also skip their scheduled dose of Prandin or Starlix.

Generic Availability

* Neither Prandin nor Starlix are currently available in generic formulations.

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

References

1. Starlix [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corporation: January 2004.

2. Prandin [package insert]. Princeton, NJ: Novo Nordisk Pharmaceuticals, Inc.; June 2006.

3. Dornhorst A. Insulinotropic meglitinide analogues. Lancet. 2001;358:1709-1716.

4. Bell DS. Importance of postprandial glucose control. South Med J. 2001;94(8):804-809.

5. Levien TL, Baker DE, Campbell RK, White Jr JR. Nateglinide therapy for type 2 diabetes mellitus. Ann Pharmacother. 2001;35;1426-1434.

6. Inzucchi SE. Oral antihyperglycemic therapy for type 2 diabetes. Scientific review. JAMA. 2002;287(3):360-372.

7. Landgraf R. Meglitinide analogues in the treatment of type 2 diabetes mellitus. Drugs Aging. 2000;17(5):411-425.

8. Walter Y, Brookman L, Ma P, et al. Reduced risk of delayed hypoglycemia with nateglinide compared to repaglinide. Diabetes. 2000;S1:521.

9. Kalbag JB, Walter YH, Nedelman JR, McLeod JF. Mealtime glucose regulation with nateglinide in healthy volunteers. Comparison with repaglinide and placebo. Diabetes Care. 2001;24(1):73-77.

10. Rosenstock J, Hassman DR, Madder RD, et al. Repaglinide versus nateglinide monotherapy: a randomized multicenter study. Diabetes Care. 2004; 27:1265-1269.

11. Raskin R, Klaff L, McGill J, et al. Efficacy and safety of combination therapy: repaglinide plus metformin versus nateglinide plus metformin. Diabetes Care 2003; 26:2063-2068.