Article Text

  1. Gonzalez D. de Serna,
  2. I. Robinson,
  3. P. Martin,
  4. M. R. Burge,
  5. D. S. Schade
  1. UNM School of Medicine, Albuquerque, NM


Purpose There is controversy regarding the optimal choice of an insulin secretagogue to prevent hyperglycemia during the postprandial period. Therefore, we compared the effect of a short- (nateglinide), intermediate- (glyburide), and long-acting (extended-release glipizide) insulin secretagogue versus placebo during the 6-hour postprandial period.

Methods We conducted a single-blind, randomized, crossover study in six non-insulin-requiring subjects with type 2 diabetes. Each subject completed four arms: placebo, nateglinide, glyburide, and extended-release glipizide. Subjects took the study medication for 7 days prior to being admitted to the General Clinical Research Center for study. The study included administration of study medication followed by a test meal. Frequent blood samples were drawn for glucose, insulin, and C-peptide before and for 6 hours after the test meal.

Results As expected, glucose levels were higher throughout the study in the placebo arm (p < .05). However, there were no statistical differences in glucose, insulin, or C-peptide levels between short-, intermediate-, and long-acting insulin secretagogues (p > .05). The incidence of hypoglycemia events was greatest with glyburide. The calculated cost per month of each medication at its recommended dose was: nateglinide ($105) > glyburide ($24) > extended-release glipizide ($14).

Conclusions Our results demonstrate that during the postprandial period none of the insulin secretagogues studied showed significantly better glucose, insulin, or C-peptide response. Thus, when choosing an insulin secretagogue, health care providers should base their decisions on cost and convenience of use.

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