Use of Short-Acting Insulin Secretagogues for Type 2 Diabetes Mellitus

Diabetes mellitus and its related complications impose a tremendous burden on patients, providers, and healthcare systems worldwide. Pharmaceutical treatments that are effective in reducing and sustaining low glucose levels safely, and reducing long-term diabetic complications, may also make a substantial contribution to reducing costs.Recently, a new class of short-acting insulin secretatogues was introduced for clinical use. Short-acting insulin secretatogues act directly on the pancreatic β cells to stimulate insulin release, thereby decreasing blood glucose levels and glycosylated hemoglobin and controlling postprandial blood glucose. Clinical trials of the short-acting insulin secretatogues, nateglinide and repaglinide, have shown efficacy and safety as monotherapy and in combination therapy in patients with type 2 diabetes. However, the higher cost of these drugs relative to older treatments and the scarcity of long-term studies that demonstrate their long-term value in terms of delaying diabetes progression, reducing diabetes-related complications and mortality, and improving patient compliance, may be limiting their adoption as first-line treatment of type 2 diabetes.