[Insulin secretion and repaglinide]

The natural history of type 2 diabetes involves a progressive pancreatic beta-cell dysfunction leading to quantitative, qualitative and/or temporal abnormalities in insulin secretion and insensitivity to insulin action which predominates in muscles. These abnormalities can be observed during early phases of glucose intolerance, but their determinism remains unclear. The high prevalence of type 2 diabetes, its increasing incidence among developed countries and the huge cost induced by diabetic complications explain why this disease is being viewed as a major public health issue. An earlier diagnosis by general practitioners and more intensive treatments are urged for patient and social beneficial outcome. In addition to non pharmacological (dietary, physical activity) approaches, several drugs were established as efficient therapies for type 2 diabetic patients: sulfonylureas acting by enhancing insulin secretion, metformin improving insulin resistance, or acarbose delaying carbohydrate intestinal absorption. These drugs have been used during the UKPDS trial; nevertheless, their effect was somehow limited, when considering long-term blood glucose control, risk for hypoglycemia, and/or prevention of macroangiopathy. The new generation of insulin secretion enhancers, including repaglinide, by allowing a reduction of total insulinemia, potentiating nutrient-induced insulin secretion, and minimizing risks for hypoglycemia, raises hope for a progress.