Flexible prandial glucose regulation with repaglinide in patients with Type 2 diabetes

Repaglinide is a novel, rapid-acting prandial glucose regulator. To investi gate the effect of repaglinide, 1 mg before each meal, in maintaining glyca emic control in Type 2 diabetic patients who either miss a meal or have an extra meal, 25 patients were randomized to either a fixed-meal regimen of t hree meals/day or one of two mixed-meal regimens consisting of repeating pa tterns of two, three or four meals/day over a 20-day period. On the 21st da y each patient received three meals. Overall glycaemic control was assessed by weekly serum fructosamine concentrations and 13-point and 37-point seru m glucose profiles. Mean fructosamine concentrations decreased significantl y to normal values during the treatment period (from 3.10 to 2.68 mg/dl on the fu;ed-meal regimen and from 3.37 to 2.85 mg/dl on the mixed-meal regime ns; P < 0.05), with no statistically significant difference in glucose cont rol between the fixed-meal and mixed-meal regimen groups. Fasting serum glu cose levels decreased slightly in both groups, but were not altered by the number of meals consumed. Similarly, serum glucose profiles were not altere d significantly by the number of meals consumed. Repaglinide was well toler ated, and no hypoglycaemic events were reported. Serum cholesterol levels w ere significantly reduced (P < 0.05) in both the fixed-meal and mixed-meal groups, as were triglyceride levels in the mixed-meal group (P < 0.05). It was concluded that meal-associated treatment with repaglinide was well tole rated irrespective of the number of meals consumed/day. Thus, since missing or postponing a meal is a realistic scenario for many individuals, repagli nide offers an oral anti-diabetic treatment which can be adjusted to suit e ach individual's lifestyle. (C) 1999 Elsevier Science Ireland Ltd. All righ ts reserved.