Non-Sulfonylurea Insulin Secretagogues

Aka: Non-Sulfonylurea Insulin Secretagogues, Meglitinide, Repaglinide, Prandin, Nateglinide, Starlix

1. See Also
   1. Second Generation Sulfonylurea
2. Mechanism
   1. Insulin secretogogue
3. Indication
   1. Early Type II Diabetes Mellitus Oral Agent
   2. Elevated postprandial Glucose
   3. Consider if only used intermittently pre-meal
4. Contraindications
   1. Hypersensitivity Reaction to sulfa
5. Category
   1. Insulin Secretagogue
6. Mechanism
   1. Benzoic acid derivative
   2. Similar to Sulfonylurea
      1. Binds different sites from Sulfonylureas
      2. Closes ATP sensitive K+ channels
      3. Results in Insulin secretion
      4. Shorter duration of binding and shorter effect
   3. Predominately effects postprandial Glucose
7. Advantages
   1. Low risk of Hypoglycemia (2.4%)
   2. Effect depends on Ambient Blood Glucose levels
   3. No significant gastrointestinal side effects
   4. Minimal weight gain
   5. No lab monitoring required
   6. No significant drug interactions
   7. No Lactic Acidosis
   8. No adjustments needed (other than per meal)
      1. No adjustment in Congestive Heart Failure
      2. No adjustment for age
      3. No adjustment in renal insufficiency
8. Adverse Effects
   1. Hypoglycemia (lower risk of Sulfonylureas)
9. Disadvantages
   1. Two to three times as expensive as Sulfonylureas
10. Agents
    1. Repaglinide (Prandin)
    2. Nateglinide (Starlix)
       1. Significantly weaker activity compared with Prandin
11. References
    1. Luna (2001) Am Fam Physician 63(9):1747-56
    2. Luna (1999) Prim Care 26:895-915