A reader recently posted a comment about sulfonylureas, which is the class of medicines I addressed last week. She wondered why anyone would take a sulfonylurea anymore when there are newer, more effective drugs out there.
She makes a good point. However, I thought I’d share my thoughts on this issue: First, there really isn’t one “right” diabetes medicine that will work for everyone. Second, all medicines, new and old, have side effects, and you and your healthcare provider need to weigh the pros and cons of whatever medicine you may be taking. Third, she raised the issue of sulfonylureas leading to something called “insulin burnout.” Sulfonylureas stimulate the pancreas to release insulin, but some researchers believe that they may lead to a more rapid decline in beta cell (insulin-producing cell) function, but not all researchers agree with this. Is it a valid concern? Yes, and one that you might talk to your doctor about. Finally, sulfonylureas are much less expensive than some of the newer diabetes drugs out there. Cost is a prime factor for many people when deciding on a medication. Bottom line: Weigh the pros and cons and do this with the guidance of your doctor.
Now, back to this week’s choice of topic: meglitinides.
What are meglitinides?
Chances are, you’re not familiar with the term “meglitinides.” These meds are cousins of sulfonylureas, and they’re often called “nonsulfonylurea secretagogues” (try out that term at the next family reunion!) or “glinides.” Like sulfonylureas, these meds increase insulin secretion from the pancreas. However, they have a much shorter duration of action; in other words, they come and go.
Within this class of drugs are repaglinide (brand name Prandin) and nateglinide (Starlix). These drugs are often combined with other diabetes pills (except for sulfonylureas), but they can be used as monotherapy (on their own), as well. Repaglinide is also available as a combination pill with metformin, called Prandimet. Meglitinides primarily work to lower blood sugar levels after meals, which, in turn, helps to lower A1C (also known as HbA1c) levels. They’re about as effective as sulfonylureas in lowering A1C levels; studies show that they can reduce A1C by 0.5% to 1.5% or more.
How are meglitinides taken?
Because these drugs are fast acting, they must be taken right before each meal. So, if you eat breakfast, lunch and dinner every day, you’d need to take your meglitinide right before or at each of your meals. However, if you miss a meal, you don’t take the medicine.
Repaglinide comes in tablets ranging from 0.5–2 milligrams (mg), and dosing is generally 0.5–4 mg three to four times daily. Nateglinide comes in 60- and 120-mg tablets, with dosing ranging from 60–120 mg three times daily. Typically, your doctor will start you off at the lowest dose and gradually increase the dose until blood glucose goals are reached. Again, meglitinides may be appealing for people who tend to vary the frequency of their meals or who tend to skip meals.
What are the side effects of meglitinides?
The most common side effect of meglitinides is hypoglycemia, or low blood sugar. This makes sense, given that these drugs prompt the pancreas to secrete insulin. Repaglinide is more likely to cause low blood sugar than nateglinide. However, it’s important to know that not everyone who takes these drugs will have low blood sugar. Weight gain is another potential side effect (more common with repaglinide), but again, this doesn’t happen to everyone. Gastrointestinal upset, upper respiratory infection and back pain are less-common side effects.
What else should you know about meglitinides?
These medicines may interact with other medicines that you’re taking, including gemfibrozil, blood thinners (like warfarin [brand name Coumadin]), beta blockers and NPH insulin.
Meglitinides are not approved for use in pregnant or breastfeeding women, or in children.
If you have liver or kidney disease or are elderly, meglitinides may not be a good choice for you.
As with all diabetes medicines, it’s important that you check your blood sugar levels when taking a meglitinide. Include some before-meal and after-meal blood sugar checks so that you and your doctor can evaluate how well this medicine is working for you.
Want to learn more about the role of medicines in treating diabetes? Read the rest of diabetes educator Amy Campbell’s eight-part series on diabetes drugs, covering metformin, sulfonylureas, thiazolidinediones, DPP-4 inhibitors, SGLT2 inhibitors, alpha-glucosidase inhibitors, bile acid sequestrants and dopamine receptor agonists, non-insulin injectable diabetes medications, and insulin.