These are recently developed oral hypoglycemic drugs and examples are repaglinide and nateglinide. They are short acting and given immediately before meal to reduce meal related glucose level in type-2 diabetes patients. Meglitinides are derivatives of amino acid phenylalanine (D-isomer).

Mechanism of action of meglitinides:

The mechanism of action of meglitinides (repaglinide and nateglinide) is same as sulfonylureas and act by binding on the “sulfonylurea receptors”, although they are not sulfonylureas.

Repaglinide:

Repaglinide induce a rapid and short lasting insulin release. Repaglinide should be taken before every major meal to control postprandial hyperglycemia in type-2 diabetes patients. If a meal is missed doe of repaglinide should be omitted.

Because repaglinide is a short acting drug it has lower risk of severe hyperglycemia and side effects such as headache, weight gain, dyspepsia, arthralgia etc. are also mild.

Uses of repaglinide:

It is indicated in type-2 diabetes as an alternative to sulfonylureas, especially if a patient is hypersensitive to sulfonylureas. Repaglinide is also used to supplement long acting insulin or metformin. Avoid repaglinide in liver disease.

Nateglinide:

Nateglinide is a derivative of amino acid D-phenylalanine which mainly stimulates the “first phase” insulin release, which occurs within 2 minutes of glucose ingestion, in response to glucose or meal and has no effect on “second phase” of insulin release. Nateglinide is shorter acting than repaglinide and causes more rapid action. Nateglinide acts should be taken 10-20 minutes before meal to prevent postprandial hyperglycemia without producing late phase hypoglycemia. Because nateglinide is very short acting there is little or no effect on fasting blood glucose level. The incidence of hypoglycemia with nateglinide is much less than with sulfonylureas.

Side effects of nateglinide are less frequent and include nausea, joint pain, dizziness, flu like symptoms etc.

Uses of nateglinide:

Nateglinide is used in type-2 diabetes, generally along with other oral hypoglycemic drugs to control postprandial blood glucose level.