Pre‐prandial vs. post‐prandial capillary glucose measurements as targets for repaglinide dose titration in people with diet‐treated or metformin‐treated Type 2 diabetes: a randomized controlled clinical trial
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AbstractObjective Repaglinide is an oral anti‐diabetic agent that has a short duration of action, and is suitable for preventing post‐prandial rises in glucose levels. Targeting post‐prandial glucose levels may lead to lower HbA1c levels and rates of hypoglycaemia than targeting pre‐prandial glucose levels.Research design and methods In 42 centres, 193 drug‐naïve (n = 122) or metformin‐treated (n = 71) individuals with Type 2 diabetes were randomly allocated to a 40‐day period of repaglinide dose‐titration (starting at 0.5 mg three times daily) based on either self‐measured pre‐prandial or post‐prandial glucose levels. They were followed for a further 12 weeks and HbA1c and hypoglycaemia rates were recorded.Results Repaglinide reduced HbA1c by 1.25 and 1.07% in the post‐prandial and pre‐prandial groups, respectively (P for difference = 0.6), and achieved target glucose levels in 80.7 and 66.7%, respectively (P = 0.16). The effect of titration strategy differed by baseline drug therapy, and was more effective in the metformin‐treated individuals who experienced a HbA1c fall of 0.6 vs. 1.10% with pre‐prandial vs. post‐prandial titration (P for metformin‐allocated group interaction = 0.043). The rate of hypoglycaemia did not differ by group.Conclusions In drug‐naïve individuals with Type 2 diabetes, similar HbA1c levels are achieved with repaglinide when dosing is adjusted according to either post‐prandial or pre‐prandial levels. Conversely, in metformin‐treated individuals, repaglinide dosing according to post‐prandial levels may lead to better glycaemic control than dosing according to pre‐prandial levels.
