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Evidence summaries

Meglitinide Analogues (Glinides) for Type 2 Diabetes Mellitus

Meglitinides are effective in type 2 diabetes compared with placebo. However, there is no evidence on important long-term outcomes, particularly mortality. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 15 studies with a total of 3781 subjects. No studies reported the effect of meglitinides on mortality or morbidity. In the eleven studies comparing meglitinides to placebo, both repaglinide and nateglinide resulted in a reductions in glycosylated haemoglobin (0.1% to 2.1% reduction in HbA1c for repaglinide; 0.2% to 0.6% for nateglinide). Repaglinide (248 participants in three trials) had a similar degree of effect in reducing glycosylated haemoglobin as metformin. Weight gain was generally greater in those treated with meglitinides compared with metformin (up to three kg in three months). Diarrhoea occurred less frequently and hypoglycaemia occurred more frequently but rarely severely enough as to require assistance.

A network meta-analysis 2 included 39 RCTs involving 17 860 individuals. Glucagon-like peptide-1 (GLP-1) analogues resulted in greater decrease in HbA1c compared with sulfonylureas (-0.20% ,95% CI -0.34 to -0.04%), glinides (-0.31%, 95% CI -0.61 to -0.02%), thiazolidinediones (-0.20%, 95% CI -0.38 to -0.00), α-glucosidase inhibitors (-0.36%, 95% CI -0.64 to -0.07%), and DPP-4 inhibitors (-0.32%, 95% CI -0.47 to -0.17%). HbA1c decrease was greater for biphasic insulin compared with glinides (-0.36%; 95% CI -0.82 to -0.11%). Compared with placebo, the risk of hypoglycaemia was increased in the sulfonylureas, glinides, basal insulin and biphasic insulin. Weight increase was seen with sulfonylureas, glinides, thiazolidinediones, basal insulin and biphasic insulin.

    References

    • Black C, Donnelly P, McIntyre L, Royle PL, Shepherd JP, Thomas S. Meglitinide analogues for type 2 diabetes mellitus. Cochrane Database Syst Rev 2007 Apr 18;(2):CD004654. [PubMed]
    • Liu SC, Tu YK, Chien MN et al. Effect of antidiabetic agents added to metformin on glycaemic control, hypoglycaemia and weight change in patients with type 2 diabetes: a network meta-analysis. Diabetes Obes Metab 2012;14(9):810-20. [PubMed]

Primary/Secondary Keywords