Switch from metformin monotherapy to bitherapy with metformin and repaglinide to achieve glycated haemoglobin target in type 2 diabetes (REPAMET Study)

摘要

Aim: To evaluate glycaemic control, including HbA_(1c), following the addition of repaglinide to monotherapy with metformin as part of routine follow-up of adult type 2 diabetes patients no longer controlled with metformin (i.e. in secondary monotherapy failure). Subjects and methods: Prospective, open-label, observational study in primary care setting, consisting of 2 visits (metformin/repaglinide bitherapy initiation and follow-up within 10-20 weeks), with analysis of HbA_(1c) levels, fasting glycaemia, body mass index and hypoglycaemic episodes within past month. Results: 2171 patients were included, with average diabetes duration (mean +- 1 SD) 7 +- 6 years, BMI 30.2 +- 5.5 kg/m~2, and fasting glucose at entry 179 +- 50 mg/dl. Mean decrements in fasting glycaemia and HbA_(1c) between visits rose with increasing HbA_(1c) at Visit 1. The proportion of patients with controlled fasting glycaemia increased by an absolute 40% for therapeutic goal set at 90-130 mg/dl. Treatment goal (HbA_(1c) < 7.0%) was achieved by 38% of patients at Visit 2, with number of patients with HbA_(1c) > 8.0% decreasing by an absolute 34%. The percentage of patients experiencing >=1 hypoglycaemic episode(s) within the previous month marginally rose from 5.0 to 5.6%. Conclusion: Combining metformin with repaglinide appears a safe and effective therapeutic option once monotherapy with metformin is no longer adequate in adult patients with type 2 diabetes followed in a primary care setting.