Insulin secretion and repaglinide

The natural history of type 2 diabetes involves a progressive pancreatic be ta-cell dysfunction leading to quantitative, qualitative and/or temporal ab normalities in insulin secretion and insensitivity to insulin action which predominates in muscles. These abnormalities can be observed during early p hases of glucose intolerance, but their determinism remains unclear. The high prevalence of type 2 diabetes, its increasing incidence among deve loped countries and the huge cost induced by diabetic complications explain why this disease is being viewed as a major public health issue. An earlie r diagnosis by general pratictioners and more intensive treatments are urge d for patient and social beneficial outcome. In addition to non pharmacological (dietary, physical activity) approaches, several drugs were established as efficient therapies for type 2 diabetic patients : sulfonylureas acting by enhancing insulin secretion, metformin i mproving insulin resistance, or acarbose delaying carbohydrate intestinal a bsorption. These drugs have been used during the UKPDS trial; nevertheless, their effect was somehow limited, when considering long-term blood glucose control, risk for hypoglycemia, and/or prevention of macroangiopathy. The new generation of insulin secretion enhancers, including repaglinide, by al lowing a reduction of total insulinemia, potentiating nutrient-induced insu lin secretion, and minimizing risks for hypoglycemia, raises hope for a pro gress.