What Are Meglitinides?Meglitinides are oral medications used in the treatment of type 2 diabetes. Medications in this class include Prandin (repaglinide) and Starlix (nateglinide).
What Do Meglitinides Do?In the human body, insulin is produced by specialized cells in the pancreas. These are called beta cells. In people with type 2 diabetes, the beta cells produce less insulin, making blood sugar levels harder to control. Meglitinides stimulate the beta cells to produce more insulin, helping the body to better process glucose (sugar) and to lower blood sugar levels.
Meglitinides are relatively short-acting medications. They allow for more flexible meal timing than longer-acting diabetes meds that require meals to be on a more fixed schedule.
What They Do Not DoWhile meglitinides help produce more insulin in patients who still produce some from the pancreas, they do not directly reduce blood sugar. Therefore, meglitinides are not a substitute for insulin, and are not appropriate for patients with type 1 diabetes.
History of UseMeglitinides have been approved by the FDA for the treatment of type 2 diabetes since 1997. They are typically taken with meals, two to four times daily, depending on eating patterns. Meglitinides can be used alone or in combination with other medications.
Recent studies indicate that repaglinide is comparable to other oral anti-diabetes medications for lowering blood sugar. Nateglinide, while useful, may be somewhat less effective at lowering blood sugar levels than other anti-diabetes medications.
Who Should Not Use Them?People with type 1 (insulin-dependent) diabetes or allergies to meglitinides should not use them.
Patients currently experiencing physical stress caused by infection, injury or surgery may need to temporarily stop taking meglitinides. In addition, meglitinides must be taken only with food; if a person misses a meal, he or she should skip a dose.
What Are the Side Effects and Risks?Low blood sugar (hypoglycemia) is the most common side effect of meglitinides. Symptoms of hypoglycemia include sweating, shakiness, lightheadedness and possible confusion. Someone experiencing hypoglycemia should consume some form of glucose, such as milk or juice. Anyone experiencing signs of diabetic coma, including confusion or loss of consciousness, should seek immediate medical attention.
Using meglitinides in combination with NPH (longer-acting) insulin can lead to a risk of cardiac problems.
Repaglinide can cause modest weight gain (2 to10 pounds).
What Are Other “Off-Label” Uses?Meglitinides are not currently being used for any “off-label” indications, although repaglinide demonstrates a slight lowering effect on triglyceride levels in the blood. This may help to reduce cardiac risk, which is part of maintaining a heart-healthy lifestyle to reduce the impact of diabetes.
What Else Should I Know?Meglitinides have the potential to interact with other medications. It is important for people who take them to review all of their current medications with their health care providers first. People with diabetes should also talk to their health care providers before taking any over-the-counter medications or herbal supplements.
Bolen, Shari. "Systematic Review: Comparative Effectiveness and Safety of Oral Medications for Type 2 Diabetes Mellitus." Annals of Internal Medicine 147(18 Sep. 2007). <http://www.annals.org/cgi/content/full/0000605-200709180-00178v1>.
Bolen, Shari, et al. "Comparative effectiveness and safety of oral medications for adults with type 2 diabetes." Agency for Healthcare Research and Quality: Reports. 15 Jul 2007. U.S. Department of Health and Human Services. 11 Sep 2007 <http://effectivehealthcare.ahrq.gov/reports>.
McCullouch, David K. "Sulfonylureas and Meglitinides in the Treatment of Diabetes Mellitus." UpToDate.com. 2007. UpToDate. 7 Sep 2007 (subscription) <http://www.utdol.com/utd/content/topic.do?topicKey=diabetes/22698&selectedTitle=6~25&source=search_result >.