The benefit of glinides in the treatment of type 2 diabetes is not scientifically proven. Nor do they perform better than other antidiabetics available in tablet form, such as metformin and sulfonylureas. As a result, there is also no proof of additional benefit. Although repaglinide has been approved for 10 years and nateglinide for 8 years in Germany, there have been no relevant trials to date of longer duration than 14 months. This is the conclusion of a report by the German Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, which was published in June 2009 and for which an English-language summary is now available.
Therapy option for patients with diabetes mellitus type 2
Usually, treatment for diabetes mellitus type 2, formerly known as adult-onset diabetes, starts with non-drug therapies, such as dietary changes, weight loss and physical exercise. If this does not reduce glucose levels sufficiently, then drugs can be used as well.
In addition to insulin, these include the oral antidiabetics (OAD). Besides glinides, this group also contains sulfonylureas, metformin and glitazones, for example. The individual substances, however, differ in their mechanism of action. Glinides stimulate the production of insulin in the pancreas. A particular feature of glinides is their rapid effect: if taken before meals, glinides lower glucose levels comparatively rapidly after eating.
At present, two substances from the drug class of glinides are approved in Germany and are thus the subject of this IQWiG investigation: repaglinide (NovoNorm from NovoNordisk) and nateglinide (Starlix from Novartis). There is, however, a slight difference in the approval of the two substances: while repaglinide is approved both as a monotherapy and as a therapy in combination with metformin, here in Germany nateglinide may only be prescribed in combination with metformin.
No long-term trials available
|Contact: Dr. Anna-Sabine Ernst|
Institute for Quality and Efficiency in Health Care