Safety and Efficacy of Meglitinides in Combination with GLP-1 Analogues- A Case Series
Abstract
Introduction Sulphonylureas (SU) and GLP-1 analogues (GLP1a) are commonly used therapeutic modalities for patients with Type 2 diabetes. Sulphonylureas and Meglitinides, both work as insulin secretagogues, by binding to the SUR subunits of the K+ATP channels of the beta-cells of the pancreatic islets [1] and short duration of action of the Meglitinides contributes to their lower risk for hypoglycaemia when compared to SUs [2,3]. GLP1a are known to induce glucose augmented insulin release and have a low incidence of hypoglycaemia-seen mostly when used in combination with a SU [4]. There have been no reported studies to date, reporting usage of the combination of Meglitinides and GLP1a with or without metformin therapy. Method and Patients Between November 2011 and March 2012, 5 patients with Type 2 Diabetes had reported recurrent pre-lunch hypoglycaemia at our Secondary Care Diabetes clinic at Westmoreland General Hospital, Kendal. All of them were on treatment with a SU (Gliclazide 80-160mg/day) and a GLP1a (Exenatide 10mcg BD/ Liraglutide 1.2mg OD) along with Metformin (1.7-2.55g/day). The choice of the GLP1a was decided prior to the study period, depending on whether patients agreed to once or twice daily injections. Gliclazide was replaced by Nateglinide/Repaglinide and their dose titrated with informed consent of the patient. Generic Nateglinide was preferred after the first patient was started on Repaglinide, because of cost-effectiveness. They all continued with their…
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