Comparison of daytime 12-hour metabolic profiles after treatment with repaglinide and gliclazide in type 2 diabetes

摘要

This study aimed to compare the effect of repaglinide and gliclazide on glucose and pancreatic beta-cell secretory products in response to serial test meals, over a 12-hour period during the day, in patients with type 2 diabetes (T2DM). T2DM subjects (n=12), on metformin and repaglinide three times a day preprandially, underwent baseline 12-hour glucose and hormonal (specific insulin and intact proinsulin) daytime profiles in response to three identical standard 500kcal test meals 4 hours apart. Subjects were then switched from repaglinide to twice-daily gliclazide for the study period of three months, after which the 12-hour profiles were repeated under identical conditions. Fasting plasma glucose, insulin and intact proinsulin concentrations were similar with the two treatments. Postprandial glucose excursions were significantly lower with repaglinide for both Meals 1 and 2 (both p<0.05). Insulin to glucose ratios were significantly greater with repaglinide in response to Meal 1 (p<0.01). Postprandial insulin and intact proinsulin (all p<0.01) responses were also significantly higher with repaglinide after the first meal. Repaglinide is a more potent and shorter-acting insulin secretagogue but its effects are predominantly in response to the first meal of the day, which may be influenced by the relatively higher beta-cell secretory capacity after a period of fasting.