Comparison of repaglinide and metformin monotherapy as an initial therapy in Chinese patients with newly diagnosed type 2 diabetes mellitus

Abstract

Background: We aimed to compare the effect of repaglinide and metformin monotherapy as an initial therapy in Chinese patients with newly diagnosed type 2 diabetes mellitus (T2DM). Patients and methods: In this 15-week, open-labelled, parallel-controlled, randomised study, 60 Chinese drug-naive patients with newly diagnosed T2DM were randomised (2:1) to receive repaglinide or metformin monotherapy. Primary endpoint was change in HbA1c from baseline to the end of the trial. Secondary endpoints included changes in glycaemic variability, insulin sensitivity and b-cell function. Results: Patients in both repaglinide and metformin groups achieved significant reductions in HbA1c (K1.8G1.5 vs K1.6G1.5%), FPG (fasting blood glucose) (K1.7G1.7 vs K2.1G1.7 mmol/l) and 2-h PPG (post-prandial glucose) (K3.8G3.1 vs K3.8G3.6 mmol/l), with no statistical differences between the groups. Glycaemic variability, glucose infusion rate and b-cell function were all significantly improved from baseline in the two groups (all P!0.05), without any statistical differences in the improvement between the groups. Conclusions: Repaglinide and metformin achieved comparable efficacy in improving glycaemic control, reducing glycaemic variability, enhancing insulin sensitivity and ameliorating b-cell function. Therefore, repaglinide is an optional agent for initial therapy in Chinese patients with newly diagnosed T2DM.

NICE guidelines for Type 2 diabetes: revised but still not fit for purpose

“…Of these seven papers, using simple critical appraisal tools such as PICO [13] and CASP [14], it is clear that three [15][16][17] should not have been included in the analysis. The third paper is a small pilot study from China [17]. The third paper is a small pilot study from China [17].…”

“…Two from Pakistan appear to report on the same cohort of 100 patients [15,16] inflating the numbers in the network meta-analyses and raising probity issues in these papers. The drug dosage comparators in all seven repaglinide studies [15][16][17][18][19][20][21] also make any sensible comparison difficult because doses ranged from 1.5 to 16 mg, whereas there were only three dose steps for the sulfonylurea glibenclamide. All three studies are underpowered, open to treatment bias in their design and the population cohorts bear no relationship to the UK given that the patients are much younger and with a much lower BMI and much higher HbA 1c than found in the average south Asian UK patient with Type 2 diabetes.…”

“…Considering the case of repaglinide, taken from the references provided by NICE [1], there appear to be seven papers on monotherapy with repaglinide of which four have been published since CG87. Of these seven papers, using simple critical appraisal tools such as PICO [13] and CASP [14], it is clear that three [15][16][17] should not have been included in the analysis. Two from Pakistan appear to report on the same cohort of 100 patients [15,16] inflating the numbers in the network meta-analyses and raising probity issues in these papers.…”

A variant of GRK5 is associated with the therapeutic efficacy of repaglinide in Chinese Han patients with type 2 diabetes mellitus

“…With respect to the result that PINS decreased in the TT genotype group while it increased in the CC and CT genotype groups, several possible reasons are listed as follows. First, in addition to stimulating the release of insulin, repaglinide can improve insulin resistance after treatment (Fang et al, ; Li et al, ). Besides, insulin resistance is associated with exposure to high levels of insulin closely (Shanik et al, ).…”

“…In the present study, the differential values of HOMA-IR is 21. (Fang et al, 2014;Li et al, 2007). Besides, insulin resistance is associated with exposure to high levels of insulin closely (Shanik et al, 2008 to study the effect of GRK5 rs10886471 polymorphism on the therapeutic efficacy of repaglinide with larger sample size in the following work.…”