Meglitinides

The meglitinides, repaglinide and nateglinide, are short-acting insulin secretagogues that bind to an identical beta cell receptor as do SU. However, onset and duration of action are much shorter and consequently, hypoglycemia risk is reduced (59). Meglitinides are dosed preprandially (tid), which may affect adherence for some patients and the cost is substantially greater than SU. Although direct comparison studies are limited, it appears that repaglinide is equipotent to SU, with nateglinide being somewhat less effective. Meglitinides may be particularly useful in elderly patients with predominantly postprandial hyperglycemia or those who have experienced excessive hypoglycemia with the use of SU.

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