Nateglinide gaining ground for Type 2

Clinical trail findings reported recently at the annual meeting of the European Association for the Study of Diabetes in Brussels, Belgium, may mean good news for your Type 2 patients. Researchers from Baylor University Medical Center in Dallas reported that the experimental drug nateglinide, made by East Hanover, NJ-based Novartis and currently in Phase III trials, seems to correct a metabolic defect thought to play a role in Type 2 diabetes.

The drug appears to restore the natural pattern of insulin secretion at meal times, when blood glucose levels tend to rise to hazardous spikes. Similar to the action of the sulfonylurea class of drugs, nateglinide works by increasing insulin production, which in turn helps restore blood glucose to normal levels. The investigators pointed out that nateglinide has fewer side effects, such as hypoglycemia, than do the sulfonylureas.

According to the clinical trial report, the major difference between nateglinide and the sulfonylureas is that the latter promote production of insulin throughout the day, while nateglinide’s effects cease as soon as blood glucose returns to normal. This may explain the relative absence of hypoglycemia in patients taking nateglinide.

In a second study, also conducted by the Dallas researchers, the investigators discovered that nateglinide enhances the action of metformin. The combination of nateglinide and metformin "controlled overall glycemia and promises to be an excellent choice for patients with more advanced disease," wrote the investigators. They suggested that early-stage diabetics may often be effectively treated with nateglinide alone.

Edward Horton, MD, of the Joslin Diabetes Center in Boston, reported at the meeting that nateglinide has long-term benefits, as well. Horton studied the drug’s effects in 1,400 Type 2 diabetics tracked over a six-month period, and nateglinide reduced post-meal glucose spikes and reduced levels of glycosylated hemoglobin A1c.