Reduction in glucose fluctuations in elderly patients with type 2 diabetes using repaglinide: A randomized controlled trial of repaglinide vs sulfonylurea

Omori, Keiichi; Nishimura, Hiroshi; Nakamura, Akinobu; Takase, Takahiro; Cho, Kyu Yong; Ono, Kota; Manda, Naoki; Kurihara, Yoshio; Aoki, Satoshi; Atsumi, Tatsuya; Miyoshi, Hideaki

doi:10.1111/jdi.12889

Cited by 17 publications

(13 citation statements)

References 27 publications

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“…Repaglinide is the most effective agent of this class, with a moderate effect on weight gain. Use of repaglinide may be indicated for elderly patients with type 2 diabetes because of the low risk of hypoglycemia, high efficacy on postprandial hyperglycemia, and safe use in renal impairment (65).…”

Section: Diabetes Treatmentsmentioning

confidence: 99%

Diabetes and Aging: From Treatment Goals to Pharmacologic Therapy

et al. 2019

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Diabetes is becoming one of the most widespread health burning problems in the elderly. Worldwide prevalence of diabetes among subjects over 65 years was 123 million in 2017, a number that is expected to double in 2045. Old patients with diabetes have a higher risk of common geriatric syndromes, including frailty, cognitive impairment and dementia, urinary incontinence, traumatic falls and fractures, disability, side effects of polypharmacy, which have an important impact on quality of life and may interfere with anti-diabetic treatment. Because of all these factors, clinical management of type 2 diabetes in elderly patients currently represents a real challenge for the physician. Actually, the optimal glycemic target to achieve for elderly diabetic patients is still a matter of debate. The American Diabetes Association suggests a HbA1c goal <7.5% for older adults with intact cognitive and functional status, whereas, the American Association of Clinical Endocrinologists (AACE) recommends HbA1c levels of 6.5% or lower as long as it can be achieved safely, with a less stringent target (>6.5%) for patients with concurrent serious illness and at high risk of hypoglycemia. By contrast, the American College of Physicians (ACP) suggests more conservative goals (HbA1c levels between 7 and 8%) for most older patients, and a less intense pharmacotherapy, when HbA1C levels are ≤6.5%. Management of glycemic goals and antihyperglycemic treatment has to be individualized in accordance to medical history and comorbidities, giving preference to drugs that are associated with low risk of hypoglycemia. Antihyperglycemic agents considered safe and effective for type 2 diabetic older patients include: metformin (the first-line agent), pioglitazone, dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists. Insulin secretagogue agents have to be used with caution because of their significant hypoglycemic risk; if used, short-acting sulfonylureas, as gliclazide, or glinides as repaglinide, should be preferred. When using complex insulin regimen in old people with diabetes, attention should be paid for the risk of hypoglycemia. In this paper we aim to review and discuss the best glycemic targets as well as the best treatment choices for older people with type 2 diabetes based on current international guidelines.

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Section: Diabetes Treatmentsmentioning

confidence: 99%

Diabetes and Aging: From Treatment Goals to Pharmacologic Therapy

et al. 2019

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“…Repaglinide is another medication which can improve GV by promoting insulin release from the pancreas with a low risk of developing hypoglycemia (Hasslacher, 2003;Jovanovic et al, 2000). It has been reported that elderly patients with T2DM had attenuated glucose fluctuation after switching from sulfonylurea to repaglinide (Lin et al, 2011;Omori et al, 2018). In the present study, we found that acarbose add-on more remarkably reduced GV than repaglinide add-on although both of them may improve GV.…”

Section: Discussionmentioning

confidence: 41%

“…Repaglinide is a hypoglycemic drug that promotes insulin secretion and has the characteristics of quick start, short duration, and rapid metabolism. It has a low risk of hypoglycemia and great effect on postprandial hyperglycemia ( Derosa et al, 2009 ; Fang et al, 2014 ; Moses et al, 1999 ; Omori et al, 2018 ). Combined use of acarbose or repaglinide with metformin or other medications will be needed if glycemic goals are not met.…”

Section: Introductionmentioning

confidence: 99%

Acarbose-metformin is more effective in glycemic variability control than repaglinide-metformin in T2DM patients inadequately controlled with metformin: a retrospective cohort study

Xie

et al. 2020

PeerJ

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Background Acarbose and repaglinide are widely used either by themselves or in combination with other medications. However, their efficacy in diabetes control has not been compared when used in combination with metformin. Methods The present study aimed to compare their effects on glycemic variability (GV) control when taken with metformin for type 2 diabetes mellitus (T2DM) inadequately controlled with metformin alone. In this retrospective cohort study, T2DM patients who were treated with either acarbose-metformin or repaglinide-metformin combination were recruited. Either acarbose 100 mg or repaglinide 2 mg triple daily was taken for the subsequent 12 weeks in combination with metformin. Demographic data, biochemical data and 7-point glycemic self-monitoring conducted with capillary blood (SMBG) data were reviewed after one week and 12 weeks. The primary outcome including glucose control and changes in GV as well as other factors affecting GV and the incidence of hypoglycemia were also analyzed. Results Of the 305 T2DM patients enrolled, data from 273 subjects, 136 in the acarbose-metformin group (M+A) and 137 in the repaglinide-metformin group (M+R) were analyzed. Both regimens improved glycemic control at 12 weeks post commencement of new medications. GV, expressed as the mean amplitude of plasma glycemic excursions (MAGE, 5.0 ± 2.6 vs. 2.8 ± 1.6 mmol/L, p < 0.001 in M+A; 5.1 ± 2.5 vs. 2.9 ± 1.3 mmol/L, p < 0.001 in M+R), standard deviation of blood glucose (SDBG, 3.6 ± 1.3 vs. 2.0 ± 0.9 mmol/L, p < 0.001 in M+A; 3.7 ± 1.3 vs. 2.4 ± 1.3 p < 0.001 in M+R), coefficient of variation of blood glucose (CVBG, (0.30 ± 0.09 vs. 0.21 ± 0.1, p < 0.001 in M+A; 0.31 ± 0.09 vs. 0.24 ± 0.12, p < 0.001 in M+R), postprandial amplitude of glycemic excursions (PPGE, 5.2 ± 2.6 vs. 2.8 ± 1.6 mmol/L, p < 0.001 in M+A; 5.3 ± 2.5 vs. 2.9 ± 1.3 mmol/L, p < 0.001 in M+R) or largest amplitude of glycemic excursions (LAGE, 9.8 ± 3.6 vs. 5.4 ± 2.4 mmol/L, p < 0.001 in M+A; 10.1 ± 3.4 vs. 6.3 ± 3.2 mmol/L, p < 0.001 in M+R) decreased significantly after the addition of acarbose or repaglinide (p < 0.05 respectively). Compared with repaglinide-metformin, acarbose-metformin was more effective in GV control at 12 weeks post commencement of new medications (p < 0.05). This study indicates that both acarbose-metformin and repaglinide-metformin combinations could effectively reduce GV and the acarbose-metformin combination seems to be more effective than the repaglinide-metformin combination. However, this conclusion should be confirmed by future large-scaled and more comprehensive studies due to the limitations of the present study.

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“…However, the hypoglycemia risk of glinides is reportedly significantly lower than that of SU . Several studies reported that repaglinide produces less hypoglycemia than SU . Although considering the small number of patients using glinides in the present study, it would seem that at least for older individuals, glinides are more appropriately indicated compared with SU.…”

Section: Discussionmentioning

confidence: 99%

Assessing hypoglycemia frequency using flash glucose monitoring in older Japanese patients with type 2 diabetes receiving oral hypoglycemic agents

Abe

Shikuma

Suwanai

et al. 2019

Geriatrics Gerontology Int

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AimIt is important to consider hypoglycemia for glycemic control in elderly patients with type 2 diabetes. Continuous blood glucose monitoring system is an effective method to investigate blood glucose fluctuation. This study examined hypoglycemia frequency using continuous blood glucose monitoring system in older patients with type 2 diabetes.MethodsA total of 70 patients with type 2 diabetes aged >65 years, receiving oral treatment only and having a glycated hemoglobin (HbA1c) level of <8% were enrolled. Flash glucose monitoring system was used for the device. Patients were classified into three groups according to the type of medicine administered, in addition to other oral hypoglycemics, and were compared: (i) those taking sulfonylureas (SU); (ii) those taking glinides; and (iii) those who did not take either SU or glinides.ResultsThere was a significant positive correlation between the coefficient of variation and hypoglycemic frequency in all the patients, and a significant negative correlation between HbA1c and hypoglycemia in those receiving SU. When hypoglycemia was defined as glucose levels <54 mg/dL and <70 mg/dL, the cut‐off HbA1c values for developing hypoglycemia were 6.3% and 6.7%, sensitivity was 75.0% and 76.2%, and specificity was 90.9% and 77.6%, respectively.ConclusionsIn older patients with type 2 diabetes receiving SU, hypoglycemic frequency increases with decreases in HbA1c level. In particular, in patients with HbA1c levels of <6.3% receiving SU, it is necessary to consider medication modification. Geriatr Gerontol Int 2019; 19: 1030–1035.

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Reduction in glucose fluctuations in elderly patients with type 2 diabetes using repaglinide: A randomized controlled trial of repaglinide vs sulfonylurea

Abstract: Switching from SU to Repa improved GA and GA/HbA1c, and had favorable effects on glucose fluctuation in elderly patients with type 2 diabetes.

Cited by 17 publications

References 27 publications

Diabetes and Aging: From Treatment Goals to Pharmacologic Therapy

Diabetes and Aging: From Treatment Goals to Pharmacologic Therapy

Acarbose-metformin is more effective in glycemic variability control than repaglinide-metformin in T2DM patients inadequately controlled with metformin: a retrospective cohort study

Assessing hypoglycemia frequency using flash glucose monitoring in older Japanese patients with type 2 diabetes receiving oral hypoglycemic agents

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