Improvement of both fasting and postprandial glycemic control by the two-step addition of miglitol and mitiglinide to basal insulin therapy: a pilot study

Abstract

BackgroundCombination therapy consisting of basal insulin and oral hypoglycemic agents (OHAs) is effective for the treatment of type 2 diabetes (T2DM) that cannot be adequately controlled using OHAs alone. Though basal insulin with metformin or sulfonylurea is an effective therapy, it cannot reduce postprandial glycemia without the risk of hypoglycemia. We examined a two-step regimen consisting of the addition of postprandial hypoglycemic agents (an alpha-glucosidase inhibitor and a glinide) in patients whose T2DM was poorly controlled using basal insulin therapy.MethodsInpatients between the ages of 30–79 years who had T2DM and an HbA1c level of more than 7.0% were recruited. The patients were treated with once-daily insulin glargine with or without metformin, depending on the patient’s age and renal function. Insulin glargine was titrated to achieve a target fasting glucose level of 70–130 mg/dL as a first step (STEP0). If the 2-hour postprandial glucose (PBG) level was higher than the target of 180 mg/dL, miglitol treatment (150 mg/day) was initiated, with dose adjustments (75–225 mg) allowed depending on abdominal symptoms and the PBG (STEP1). If the PBG of the patients remained higher than the target after 3 days of treatment, mitiglinide (30 mg/day, titrated up to 60 mg) was added (STEP2). We then evaluated the proportion of patients who achieved the target PBG before and after the two-step regimen. Continuous Glucose Monitoring (CGM) was performed throughout the two-step protocol in most of the patients.ResultsOf the 16 patients who were recruited (median age, 67.0 [58.0-71.0] years; body mass index, 25.0 [22.0-27.9] kg/m2; HbA1c level at admission, 9.1% [8.35-10.4%]), 1 patient (6.25%) achieved the target PBG at STEP 0 and 14 patients (87.5%) had achieved the target PBG at the end of the treatment protocol (P = 0.002). CGM showed a significant decrease in the glucose level at each step of the protocol. The standard deviations in the CGM glucose levels for 24 hours, MAGE, and M-value also improved.ConclusionsThe two-step addition of postprandial hypoglycemic agents to basal insulin therapy is potentially effective and safe for decreasing both the fasting and postprandial glucose levels.

Clinic-on-a-Needle Array toward Future Minimally Invasive Wearable Artificial Pancreas Applications

“…Both cases result in an elevated concentration of blood glucose. Specifically, postprandial (i.e., after-meal) hyperglycemia is commonly defined as a blood glucose level greater than 180 mg/dL two hours after a meal . Chronic high blood glucose levels lead to pathological complications, including cardiovascular diseases, stroke, and potential nontraumatic limb amputations, as well as microvascular complications leading to kidney diseases, blindness, and neuropathy. , Thus, tight glucose control in diabetic patients which can prevent, or at least delay, the onset of its late complications is of enormous importance and has been the subject of extensive research efforts over the years .…”

Improved time in range and postprandial hyperglycemia with canagliflozin in combination with teneligliptin: Secondary analyses of the CALMER study

“…Furthermore, in this analysis, pre‐prandial hyperglycemia was improved, as well as post‐prandial hyperglycemia, in the COMB group. It is well known that alpha‐glucosidase inhibitors 36 and glinide 37 acting directly on postprandial hyperglycemia also improved pre‐prandial hyperglycemia. DPP‐4 inhibitors that improved postprandial hyperglycemia on glycemic responsiveness also improve the next pre‐prandial glucose level 38 .…”

Cross-Over Study Comparing Postprandial Glycemic Increase After Addition of a Fixed-Dose Mitiglinide/Voglibose Combination or a Dipeptidyl Peptidase-4 Inhibitor to Basal Insulin Therapy in Patients with Type 2 Diabetes Mellitus

“…Some previous studies have assessed the effects of oral postprandial hypoglycemic agents used in combination with basal therapy. We previously reported that a 2-step regimen consisting of the addition of the postprandial hypoglycemic agents miglitol and mitiglinide to basal insulin therapy enabled more than 80% of the patients to achieve a good glucose profile [ 11 ]. CGM also showed the effectiveness of miglitol and mitiglinide in lowering the daytime blood glucose levels without inducing hypoglycemia.…”

“…We previously reported that the 2-step addition of 2 postprandial hypoglycemic agents, an alpha-glucosidase inhibitor and a glinide, to basal insulin therapy was potentially effective and safe for decreasing both the fasting and postprandial glucose levels [ 11 ]. While these basal insulin therapies are commonly used for patients with insufficient glycemic control using only OHAs, which OHAs are the most efficient for use in combination with basal insulin therapy remains unclear.…”