Abstract | BACKGROUND: OBJECTIVES: SEARCH STRATEGY: We searched several databases including The Cochrane Library, MEDLINE and EMBASE. We also contacted manufacturers and searched ongoing trials databases, and the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) websites. SELECTION CRITERIA: We included randomised controlled, parallel or cross-over trials comparing at least 10 weeks of treatment with meglitinide analogues to placebo, head-to-head, metformin or in combination with insulin. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed trial quality. MAIN RESULTS: Fifteen trials involving 3781 participants were included. 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). Only two trials compared repaglinide to nateglinide (342 participants), with greater reduction in glycosylated haemoglobin in those receiving repaglinide. Repaglinide (248 participants in three trials) had a similar degree of effect in reducing glycosylated haemoglobin as metformin. Nateglinide had a similar or slightly less marked effect on glycosylated haemoglobin than metformin (one study, 355 participants). 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. AUTHORS' CONCLUSIONS: Meglitinides may offer an alternative oral hypoglycaemic agent of similar potency to metformin, and may be indicated where side effects of metformin are intolerable or where metformin is contraindicated. However, there is no evidence available to indicate what effect meglitinides will have on important long-term outcomes, particularly mortality.
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Authors | C Black, P Donnelly, L McIntyre, P L Royle, J P Shepherd, S Thomas |
Journal | The Cochrane database of systematic reviews
(Cochrane Database Syst Rev)
Issue 2
Pg. CD004654
(Apr 18 2007)
ISSN: 1469-493X [Electronic] England |
PMID | 17443551
(Publication Type: Journal Article, Review, Systematic Review)
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Chemical References |
- Benzamides
- Carbamates
- Cyclohexanes
- Hypoglycemic Agents
- Piperidines
- Nateglinide
- Phenylalanine
- repaglinide
- meglitinide
- Metformin
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Topics |
- Benzamides
(therapeutic use)
- Carbamates
(adverse effects, therapeutic use)
- Cyclohexanes
(adverse effects, therapeutic use)
- Diabetes Mellitus, Type 2
(drug therapy)
- Humans
- Hypoglycemic Agents
(adverse effects, therapeutic use)
- Metformin
(therapeutic use)
- Nateglinide
- Phenylalanine
(adverse effects, analogs & derivatives, therapeutic use)
- Piperidines
(adverse effects, therapeutic use)
- Randomized Controlled Trials as Topic
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