Purpose Nateglinide is a short-acting third-generation insulin secretagogue that is currently recommended to be administered three times a day before meals. However, this intermittent TID dosing results in poor patient compliance due to the inability to remember to take the pills. We hypothesized that administering nateglinide in a continual low-dose exposure over 24 hours would result in the same glucose control as it being administered at the recommended high dosage three times per day.
Methods We conducted a double-blind, randomized, crossover study in 10 individuals with type 2 diabetes. Each subject completed 2 inpatient hospital admissions at the General Clinical Research Center. One admission involved giving nateglinide before meals and the other admission involved giving nateglinide continuously for 24 hours. Equal amounts of nateglinide were administered during both admissions. Subjects received a standardized breakfast, lunch, and dinner. Frequent blood samples for glucose, free insulin, and C-peptide were performed throughout the study.
Results There was no statistical difference in glucose, free insulin, or C-peptide levels between nateglinide arms, whether it was given before meals or continuously throughout a 24-hour period (p > .05).
Conclusions Nateglinide can effectively be administered as a low continuous dosage in type 2 diabetes. Glucose control and insulin secretory response is the same when nateglinide is administered continuously or intermittently. Therefore, nateglinide compliance could be significantly improved by being administered once a day as an extended-release formulation.