Combination therapy for patients with Type 2 diabetes: repaglinide in combination with metformin

Abstract

In patients with Type 2 diabetes mellitus (T2DM), adequate glycemic control is a critical factor in reducing long-term micro- and macro-vascular complications. Traditionally, the approach is to initiate monotherapy first, followed by combination therapy that targets two main defects in T2DM. Repaglinide, a rapidly acting insulin secretagog, stimulates insulin secretion via closure of ATP-dependent potassium channels on the cell membrane of β-cells. Repaglinide is ideally used at mealtime to reduce postprandial glucose levels, thus lowering the 24-h blood glucose profile and improving HbA1c levels. Metformin is an insulin sensitizer that effectively acts against insulin resistance, one of the predominant metabolic defects in T2DM. A combination of repaglinide and metformin is indicated as an adjunct to diet and exercise to improve glycemic control in adults with T2DM. When monotherapy with oral antidiabetic agents fails, combination therapy with repaglinide plus metformin has been demonstrated to be safe and effective in the treatment of T2DM.

Keywords::

• biguanides
• combination therapy
• hyperglycemia
• insulin secretion
• insulin sensitivity
• meglitinide
• metformin
• repaglinide
• Type 2 diabetes mellitus

Financial & competing interests disclosure

Robert G Moses received honoraria from NovoNordisk for ad hoc expert committees, income related to clinical trials and also sponsorship to some international meetings. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Robert G Moses wishes to thank Anu Santhanagopal of DesignWrite, LLC, for providing medical writing and editorial assistance. Funding to support the preparation of this manuscript was provided by Novo Nordisk A/S.