2014早相重要性包括与唐力对比.pptVIP

* Efficacy and Safety of Combination Therapy Repaglinide plus metformin versus nateglinide plus metformin Diabetes Care. 2003;26(7):2063–2068. [PubMed: 看完联合二甲双胍，瑞格列奈与SU类的比较，那么接下来我们再看看瑞格列奈与同为格列奈类的那格列奈的比较 病程3个月以上，BMI24-42kg/m2，既往接受磺脲类药物（≥25％最大剂量）、二甲双胍(＞100mg/d)或低剂量格列本脲(≤2.5mg)+二甲双胍(≤500mg)固定复方剂型（Glucovance）, 7％ ＜HbA1c≤12％ OBJECTIVE— An open-label, parallel-group, randomized, multicenter trial was conducted to compare efficacy and safety of repaglinide versus nateglinide, when used in a combination regimen with metformin for treatment of type 2 diabetes. RESEARCH DESIGN AND METHODS— Enrolled patients (n 192) had HbA1c 7% and 12% during previous treatment with a sulfonylurea, metformin, or low-dose Glucovance (glyburide 2.5 mg, metformin 500 mg). After a 4-week metformin run-in therapy period (doses escalated to 1,000 mg b.i.d.), patients were randomized to addition of repaglinide (n 96) (1 mg/meal, maximum 4 mg/meal) or nateglinide (n 96) (120 mg/meal, reduced to 60 mg if needed) to the regimen for 16 weeks. Glucose, insulin, and glucagon were assessed after a liquid test meal at baseline and week 16. RESULTS— Final HbA1c values were lower for repaglinide/metformin treatment than for nateglinide/metformin (7.1 vs. 7.5%). Repaglinide/metformin therapy showed significantly greater mean reductions of HbA1c (–1.28 vs. –0.67%; P 0.001) and of fasting plasma glucose (FPG) (–39 vs. –21 mg/dl; P 0.002). Self-monitoring of blood glucose profiles were significantly lower for repaglinide/metformin before breakfast, before lunch, and at 2:00 A.M. Changes in the area under the curve of postprandial glucose, insulin, or glucagon peaks after a test meal were not significantly different for the two treatment groups during this study. Median final doses were 5.0 mg/day for repaglinide and 360 mg/day for nateglinide. Safety assessments were comparable for the two regimens. CONCLUSIONS— The addition of repaglinide to metformin therapy resulted in reductions of HbA1c a