Rapid-Acting Prandial Insulin Releasers
Under experimental conditions the first phase of glucose-stimulated insulin secretion is diminished early in natural history of type 2 diabetes. The prompt physiological rise in plasma insulin in response to meals is attenuated and its peak delayed. An inittial surge of insulin release appears to be particularly important for effective postprandial suppression of hepatic glucose production; failure to suppress endogenous glucose production exacerbates postprandial hyperglycaemia. Because postprandial hyperglycaemia contributes to elevated HbA1c levels is a logical therapeutic target. Rapid-acting prandial insulin relesers are available that stimulate rapid, but short-lived, insulin secretion. These agents are taken orally immediately before a meal. Derivatives of meglitinide, such as repaglinide and the phenylalanine derivative nateglinide, are promoted as prandial glucose regulators; in fact, fasting hyperglycaemia is also improved to a lesser extent, particularly with repaglinide. Clinical experience with these agents remains limited in mostt countries; these drugs are appreciably more expensive than most sulphonylureas, the latter also having the reassurance of outcome data from the UKPDS.
Rapid-Acting Prandial Insulin Releasers
Under experimental conditions the first phase of glucose-stimulated insulin secretion is diminished early in natural history of type 2 diabetes. The prompt physiological rise in plasma insulin in response to meals is attenuated and its peak delayed. An inittial surge of insulin release appears to be particularly important for effective postprandial suppression of hepatic glucose production; failure to suppress endogenous glucose production exacerbates postprandial hyperglycaemia. Because postprandial hyperglycaemia contributes to elevated HbA1c levels is a logical therapeutic target. Rapid-acting prandial insulin relesers are available that stimulate rapid, but short-lived, insulin secretion. These agents are taken orally immediately before a meal. Derivatives of meglitinide, such as repaglinide and the phenylalanine derivative nateglinide, are promoted as prandial glucose regulators; in fact, fasting hyperglycaemia is also improved to a lesser extent, particularly with repaglinide. Clinical experience with these agents remains limited in mostt countries; these drugs are appreciably more expensive than most sulphonylureas, the latter also having the reassurance of outcome data from the UKPDS.
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