Vol 3, No 1 (2002): Practical Diabetology
Other materials agreed with the Editors
Published online: 2001-12-06
Importance of early insulin secretion. Comparison of nateglinide and glyburide in previously diet-treated patients with type 2 diabetes
Diabetologia Praktyczna 2002;3(1):31-38.
Abstract
INTRODUCTION. This study compared the effects of
nateglinide, glyburide, and placebo on postmeal glucose
excursions and insulin secretion in previously
diet-treated patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS. This randomized, double-blind, placebo-controlled multicenter study was conducted in 152 patients who received either nateglinide (120 mg before three meals daily, n = 51), glyburide (5 mg q.d. titrated to 10 mg q.d. after 2 weeks, n = 50), or placebo (n = 51) for 8 weeks. Glucose, insulin, and C-peptide profiles during liquid meal challenges were measured at weeks 0 and 8. At weeks — 1 and 7, 19-point daytime glucose and insulin profiles, comprising three solid meals, were measured.
RESULTS. During the liquid-meal challenge, nateglinide reduced the incremental glucose area under the curve (AUC) more effectively than glyburide (D = –4.94 vs. –2.71 mmol • h/l, p < 0.05), whereas glyburide reduced fasting plasma glucose more effectively than nateglinide (D = –2.9 vs. –1.0 mmol/l, respectively, p < 0.001). In contrast, C-peptide induced by glyburide was greater than that induced by nateglinide (D = +1.83 vs. +0.95 nmol • h/l, p < 0.01), and only glyburide increased fasting insulin levels. During the solid meal challenges, nateglinide and glyburide elicited similar overall glucose control (D 12-h incremental AUC = –13.2 vs. –15.3 mmol • h/l), but the insulin AUCinduced by nateglinide was significantly less than that induced by glyburide (D 12-h AUC = +866 vs. +1,702 pmol • h/l, p = 0.01).
CONCLUSIONS. This study demonstrated that nateglinide selectively enhanced early insulin release and provided better mealtime glucose control with less total insulin exposure than glyburide.
RESEARCH DESIGN AND METHODS. This randomized, double-blind, placebo-controlled multicenter study was conducted in 152 patients who received either nateglinide (120 mg before three meals daily, n = 51), glyburide (5 mg q.d. titrated to 10 mg q.d. after 2 weeks, n = 50), or placebo (n = 51) for 8 weeks. Glucose, insulin, and C-peptide profiles during liquid meal challenges were measured at weeks 0 and 8. At weeks — 1 and 7, 19-point daytime glucose and insulin profiles, comprising three solid meals, were measured.
RESULTS. During the liquid-meal challenge, nateglinide reduced the incremental glucose area under the curve (AUC) more effectively than glyburide (D = –4.94 vs. –2.71 mmol • h/l, p < 0.05), whereas glyburide reduced fasting plasma glucose more effectively than nateglinide (D = –2.9 vs. –1.0 mmol/l, respectively, p < 0.001). In contrast, C-peptide induced by glyburide was greater than that induced by nateglinide (D = +1.83 vs. +0.95 nmol • h/l, p < 0.01), and only glyburide increased fasting insulin levels. During the solid meal challenges, nateglinide and glyburide elicited similar overall glucose control (D 12-h incremental AUC = –13.2 vs. –15.3 mmol • h/l), but the insulin AUCinduced by nateglinide was significantly less than that induced by glyburide (D 12-h AUC = +866 vs. +1,702 pmol • h/l, p = 0.01).
CONCLUSIONS. This study demonstrated that nateglinide selectively enhanced early insulin release and provided better mealtime glucose control with less total insulin exposure than glyburide.
Keywords: diabetes type 2early insulin releasepostmeal glucose excursion