Reduction in glucose fluctuations in elderly patients with type 2 diabetes using repaglinide: A randomized controlled trial of repaglinide vs sulfonylurea

• Published in: Journal of diabetes investigation Vol. 10; no. 2; pp. 367 - 374
• Main Authors: Omori, Kazuno, Nomoto, Hiroshi, Nakamura, Akinobu, Takase, Takahiro, Cho, Kyu Yong, Ono, Kota, Manda, Naoki, Kurihara, Yoshio, Aoki, Shin, Atsumi, Tatsuya, Miyoshi, Hideaki
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01.03.2019; John Wiley and Sons Inc; Wiley
• Subjects: Aged; Aged, 80 and over; Antidiabetics; Biomarkers - analysis; Blood glucose; Blood Glucose - analysis; Carbamates - therapeutic use; Clinical Trial; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - metabolism; Elderly; Female; Follow-Up Studies; Geriatrics; Glucose; Glucose variability; Glycated Hemoglobin - analysis; Hemoglobin; Humans; Hyperglycemia; Hyperglycemia - prevention & control; Hypoglycemia; Hypoglycemia - prevention & control; Hypoglycemic Agents - therapeutic use; Insulin; Insulin secretion; Male; Middle Aged; Patients; Piperidines - therapeutic use; Prognosis; Prospective Studies; Repaglinide; Secretion; Sulfonylurea; Sulfonylurea Compounds - therapeutic use; Japan; Glucose variability; Repaglinide; Elderly
• ISSN: 2040-1116; 2040-1124; 2040-1124
• DOI: 10.1111/jdi.12889

Aims/Introduction Glinides are antidiabetic drugs that enhance the early phase of insulin secretion, but have been considered to be less effective at lowering blood glucose than sulfonylureas. However, glinides show a lower risk of hypoglycemia and a greater effect on postprandial hyperglycemia, and are particularly recommended for use in elderly patients with type 2 diabetes. We investigated the efficacy and safety of repaglinide compared with sulfonylurea for the treatment of elderly patients. Materials and Methods In the present multicenter, prospective, randomized, open‐label, controlled trial, 57 elderly lean patients with type 2 diabetes who were being treated with sulfonylureas were studied. They were either switched to repaglinide (Repa group) or continued a sulfonylurea (SU group) for 12 weeks. The primary outcome comprised the change in glycemic control, and among the secondary outcomes was the presence of hypoglycemia and drug compliance. Results Although glycated hemoglobin (HbA1c) was not significantly different between the two groups (SU +0.02% vs Repa −0.07%), greater improvements in the glycated albumin (GA) and GA to HbA1c ratio (GA/HbA1c) were observed in the Repa group (ΔGA, SU +0.12% vs Repa −1.15%; ΔGA/HbA1c, SU +0.01 vs Repa −0.13; each P < 0.01) without increasing hypoglycemia. When the Repa group was subdivided according to whether GA improved, the SU dose before switching to repaglinide was significantly smaller and the homeostatic model assessment of β‐cell function was significantly higher in the GA improvement subgroup. Conclusions Switching from SU to Repa improved GA and GA/HbA1c, and had favorable effects on glucose fluctuation in elderly patients with type 2 diabetes. In this multi‐centre, prospective, randomized, open‐label, controlled trial, 57 elderly lean patients with type 2 diabetes who were being treated with sulfonylureas were studied. Switching from SU to Repa improved GA and GA/HbA1c, and had favorable effects on glucose fluctuation in elderly patients with type 2 diabetes.