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

Five-year View

In the future, the role of postprandial hyperglycemia in micro- and macro-vascular complications in T2DM is likely to be further elaborated. As a result, therapeutic strategies that target postprandial glycemia will become important treatment options. The use of α-glucosidase inhibitors will likely make a recurrence as their effect on lowering postprandial spikes is recognized. The use of rapidly acting oral agents such as repaglinide that target postprandial hyperglycemia, combined with other strategies mentioned earlier, is likely to become more common. In this context, the combination of repaglinide and metformin is particularly attractive due to improved glycemic control with minimal safety issues such as weight gain and risk of hypoglycemia. There is also a probability in the future of being able to titrate the dose of repaglinide related to the quantity and quality of carbohydrates in each meal. Postprandial hyperglycemia leads to an overproduction of superoxide radicals, and the resulting oxidative stress is thought to be an underlying mechanism for most of the diabetes-related complications. Agents such as superoxide dismutase and catalase mimetics that specifically target suppression of free radical release may become useful. It is well understood that diabetes increases the risk of cardiovascular disease. Considering that patients will receive antidiabetic therapy indefinitely, any undesirable cardiovascular effects from widely used oral antidiabetic drugs would be carefully evaluated. In this context, further understanding on the potential role of combination therapy in the global management of diabetes-related cardiovascular risk will become an area of fruitful research.

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