A time to revisit the two oldest prandial anti-diabetes agents: acarbose and repaglinide
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ORIGINAL ARTICLE
A time to revisit the two oldest prandial anti-diabetes agents: acarbose and repaglinide Parisa Pishdad1 Reza Pishdad2 Gholam Reza Pishdad3 Yunes Panahi4 ●
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Received: 26 March 2020 / Accepted: 18 June 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
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 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. Keywords Type 2 diabetes (T2D) Postprandial hyperglycemia Acarbose Repaglinide Treatment adherence ●
Introduction Epidemiological studies have shown that postprandial hyperglycemia considerably contributes to elevated HbA1C levels and is linked to the pathogenesis of chronic diabetes
* Gholam Reza Pishdad [email protected] 1
Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
3
Endocrine and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
4
Chemical Injuries Research Center, Tehran’s Baqiyatallah University of Medical Sciences, Tehran, Iran
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complications particularly cardiovascular issues [1–7]. Of all antidiabetic agents that specifically target postprandial hyperglycemia, the two oldest introduced to market are repaglinide and acarbose. These two have some outstanding qualities that the newer ones
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