Nateglinide (Starlix) and repaglinide (Prandin) are short-acting glinides given with meals. Glinides work to quickly reduce postprandial (postmeal) blood glucose levels. The shorter half-life associated with glinides may be appropriate for some patients with T2DM. On the other hand, remembering to Mechanism of action Meglitinides are short-acting glucose-lowering noninsulin antihypertensive agents. Meglitinides require a functioning pancreas to be effective. Like sulfonylureas, nateglinide (Starlix) and repaglinide (Prandin) stimulate the pancreas to release Side effects Glinides are usually well tolerated. Because they stimulate insulin release from pancreatic beta cells, hypoglycemia is the primary side effect. However, with a shorter half-life and fast onset of action, the risk of hypoglycemia is lower when taking glinides than sulfonylureas. Glinides do not work in patients who do not respond to sulfonylureas. Therefore, combining glinides and sulfonylureas is ineffective and should not be done. Dosing of meglitinides The recommended dose for meglitinides is shown in Table 4. The starting dose of repaglinide (Prandin) is 0.5 mg 30 minutes before a meal if the patient’s A1C is <8.0%. For patients with an A1C >8.0%, the initial dose of repaglinide (Prandin) is 1 to 2 mg 30 minutes before a meal. The starting dose of nateglinide (Starlix) is 60 mg before each meal if the patient is close to their A1C target. Patients who skip a meal or add a meal should be instructed to skip or add a dose for that meal, respectively. It Table 4: Noninsulin Antihyperglycemic Agents: Meglitinides Meglitinide
take a glinide with every meal may be difficult, especially for older adults (Kroon & Zhou, 2022b). Therefore, patients must understand the importance of taking glinide with their meals. Patients should not take the drug after the meal if they forgot to take it beforehand. insulin by closing the ATP-dependent potassium channel in pancreatic beta cells. The depolarization of pancreatic beta cells opens calcium channels, which induces insulin secretion. Insulin release is glucose dependent, unlike with sulfonylureas. Aside from hypoglycemia, other common side effects of taking glinides include weight gain, upper respiratory infections, sinusitis, nausea, diarrhea, constipation, arthralgia, and headache. Like sulfonylureas, weight gain is attributed to improved glycemic control and consumption of additional calories when treating hypoglycemia (Kroon & Zhou, 2022b). is important to remember that the dosing of glinides depends on monitoring blood glucose levels. Thus, different doses of glinides may be taken at different mealtimes (Kroon & Zhou, 2022b). According to 2022 guidelines for the management of hyperglycemia in type 2 diabetes, the use of meglitinides as glucose-lowering agents is not common in the U.S. (Davies et al., 2022; ElSayed et al., 2023a).
Available Strengths
Starting Dose
How to Titrate Dose
Dosage Range
Generic Name (Trade Name)
Nateglinide (Starlix)
• 60 mg • 120 mg
• Patients close to their A1C target
• Titrate up to 120
• 180–360 mg/daily.
mg or until glycemic target is reached.
should start around 60 mg/3 times daily.
Regaglinide (Prandin)
• 0.5 mg • 1 mg • 2 mg
• 0.5–1 mg/3 times daily.
• Titrate up to 2 mg or until glycemic target is reached.
• 2–16 mg/daily.
● Meglitinides may cause hypoglycemia; if prescribed a sulfonylurea, all patients and their families should know the signs and symptoms of hypoglycemia and what to do should it occur.
Key points for patients taking a meglitinide: ● Meglitinides should be taken 15 minutes before a meal. ● If you skip a meal, do not take the meglitinide.
ALPHA-GLUCOSIDASE INHIBITORS
Alpha-glucosidase inhibitors are the only class of noninsulin antihyperglycemic agents not targeted at a specific pathophysiological defect associated with T2DM. Acarbose (Precose) was introduced in the U.S. in the mid-1990s, followed by miglitol (Glyset). These agents attempt to slow the absorption Mechanism of action Alpha-glucosidase inhibitors work in the small intestine by inhibiting the enzyme alpha-glucosidase, thus delaying intestinal absorption of carbohydrates. A delay in intestinal absorption of carbohydrates results in a reduction of the postprandial hyperglycemia that occurs during the digestion of meal (McKeirnan & Rodin, 2022). Using alpha-glucosidase inhibitors inhibits the ability of amylase (acarbose only) and membrane- Side effects With alpha-glucosidase inhibitors working the gastrointestinal (GI) tract, side effects can include bloating, abdominal discomfort, flatulence, and diarrhea. Alpha-glucosidase inhibitors are contraindicated in patients with inflammatory bowel disease,
of carbohydrates to lower postprandial blood glucose levels. Patients typically do not experience hypoglycemia or weight gain unless the medication is taken in combination with another noninsulin antihyperglycemic (McKeirnan & Rodin, 2022).
bound alpha-glucosidase (acarbose and miglitol) to function in the small intestine. With the digestion of carbohydrates delayed, absorption occurs more slowly. Use of alpha-glucosidase inhibitors has played an important role in a combination regimen for patients who consume high-carbohydrate meals and have high postprandial blood glucose levels (McKeirnan & Rodin, 2022). irritable bowel syndrome, and partial intestinal obstruction (McKeirnan & Rodin, 2022). Elevated liver function tests have been reported in patients taking higher doses of alpha- glucosidase inhibitors; thus, these noninsulin antihyperglycemic
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Book Code: RPTTX2024
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