Treatment Options to Control Blood Glucose |
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Treatment Option B: Oral Antidiabetes Medication
1. Insulin secretagogue: sulfonylurea or meglitinides (eg, glipizide extended release, glimepiride, repaglinide, nateglinide)
Insulin secretagogues are indicated primarily as an adjunct to diet and exercise in patients whose glucose levels are fairly well controlled but who need additional support.4 Although these drugs may show some benefit within a few days, single agents will not usually result in the lowering of A1C by more than 1.5% to 2%.5 Unlike insulin, each of these drugs has a fixed maximum A1C-lowering capability5 (Table 1), and all sulfonylureas are capable of producing severe hypoglycemia, particularly in the elderly.6
Table 1. Effects of Various Insulin Secretagogues on A1C*| Repaglinide | -1.9% |
| Nateglinide | 0.5%–0.8% |
| Glimepiride | -2.0% |
| Glipizide | -1.3% |
| *Difference from placebo. Dosage and length of trials are not comparable. See prescribing information for individual drugs. |
The results of this patient’s fingerstick indicate that a much more intensive regimen is required. In addition, the history of unintentional weight loss suggests a high degree of ß-cell dysfunction, which may decrease the effectiveness of this class of medications.
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