Use of Short-Acting Insulin Secretagogues for Type 2 Diabetes Mellitus: Considerations for National Health Systems
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 beta 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.
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