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A time to revisit the two oldest prandial anti-diabetes agents: acarbose and repaglinide

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Abstract

Purpose

Compared with newer prandial anti-diabetes agents, repaglinide and acarbose are unique in being globally available in generic versions, being oral, and being the cheapest of all. The aim of this study was to compare their efficacy when used alone or in combination.

Methods

In a randomized, double-blind, prospective study, 358 recently diagnosed type 2 diabetes (T2D) patients, who on a combined therapy with metformin and insulin glargine had a fasting plasma glucose (FGP) of <7.2 mmol/L but a 2-h postprandial plasma glucose (2hPPG) >10 mmol/L, were assigned to three groups of additional treatment with either repaglinide, acarbose, or repaglinide-plus-acarbose for 4 months.

Results

With intention-to-treat analysis, 63% of repaglinide group, 45.4 percent of acarbose group, and 75.7% of repaglinide-plus-acarbose group reached the primary endpoint of 2hPPG < 10 mmol/L while maintaining FPG < 7.2 mmol/L. Treatment adherence rate was 75.6% with repaglinide, 61.4% with acarbose, and 81.3% with repaglinide-plus-acarbose (p = 0.001). Among the groups, weight was significantly lower in acarbose group (p < 0.05). Twenty-one percent of repaglinide patients, 4.9% of acarbose subjects, and 10.3% of repaglinide-plus-acarbose cases reported at least one episode of hypoglycemia (p < 0.005). HbA1C and basal insulin requirement were significantly lower in repaglinide group (p = 0.004, p = 0.0002). Triglycerides were lowest in acarbose group (p = 0.005).

Conclusions

Both acarbose and repaglinide were vastly effective in lowering postprandial hyperglycemia of recently diagnosed T2D. When combined, they were even more efficacious and the disease had a better outcome. Compared with newer peers, these two are particularly useful where and when cost consideration in diabetes treatment is a prime concern.

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Acknowledgements

G.R.P. is the guarantor and takes full responsibility for the work as a whole.

Funding

This study was funded by Shiraz University of Medical Sciences (grant: 90-01-01-2795).

Author information

Authors and Affiliations

  1. Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran

    Parisa Pishdad

  2. Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA

    Reza Pishdad

  3. Endocrine and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

    Gholam Reza Pishdad

  4. Chemical Injuries Research Center, Tehran’s Baqiyatallah University of Medical Sciences, Tehran, Iran

    Yunes Panahi

Authors
  1. Parisa Pishdad
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  2. Reza Pishdad
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Contributions

G.R.P., P.P., R.P., and Y.P. designed and carried out the study. R.P. and P.P. reviewed the literature and gathered references. G.R.P. analyzed the data. G.R.P., R.P., P.P., and Y.P. wrote the paper. G.R.P. had the final decision to submit the paper for publication.

Corresponding author

Correspondence to Gholam Reza Pishdad.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Pishdad, P., Pishdad, R., Pishdad, G.R. et al. A time to revisit the two oldest prandial anti-diabetes agents: acarbose and repaglinide. Endocrine 70, 307–313 (2020). https://doi.org/10.1007/s12020-020-02396-0

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