Combination Therapy for Patients with Type 2 Diabetes: Repaglinide in Combination with Metformin

Robert G Moses

Disclosures

Expert Rev Endocrinol Metab. 2010;5(3):331-342. 

In This Article

Expert Commentary

The combination of metformin, a biguanide insulin sensitizer, and repaglinide, a meglitinide insulin secretagog, has been shown to effectively reduce HbA1c levels. PrandiMet is the first and only FDC of repaglinide and metformin for the treatment of T2DM, manufactured and marketed by Novo Nordisk and Sciele Pharma, Inc. Although repaglinide and metformin have been used together for several years, PrandiMet is the first treatment option that combines both into one tablet.

Side effects such as weight gain and hypoglycemia can be significant concerns with insulin therapy and a considerable cause of concern. OADs with complementary mechanisms, used both as separate agents or in FDCs, target different causes of hyperglycemia and can help reduce issues such as hypoglycemia and weight gain. With the current trend turning toward more early and intensified treatments both with insulin and OADs, we need to consider medications in the form of combination therapy that can target both FPG and PPG.[8]

Repaglinide and metformin are widely used and well studied OADs that target different aspects of T2DM. Significant improvement in hepatic and peripheral insulin sensitivity and increased postprandial insulin secretion seen with these agents in combination leads to additive effects compared with either agent alone. When compared with a standard SU, repaglinide offers advantages with its rapid-acting glucose-dependent insulin secretion. This attribute enhances the favorable pharmacokinetic profile of the combination tablet. The FDC tablet has been shown to be both safe and well tolerated, offering comprehensive glycemic control and a low incidence of adverse events.

Pharmacoeconomic studies have suggested that repaglinide plus metformin offers economic advantages over monotherapy and other combination therapies,[82] and it has been estimated that repaglinide plus metformin could provide a significant improvement in life expectancy. In a recent review, Raskin commented that combination therapy with repaglinide plus metformin could offer a total savings of over US$3600/patient relative to treatment with nateglinide and metformin.[17]

In patients diagnosed with T2DM, lack of adherence to therapy contributes to inadequate glycemic control. Combination therapies of any kind in the form of a FDC tablet offers the patient convenience and facilitates compliance.

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