Combination therapy for patients with Type 2 diabetes: repaglinide in combination with metformin

In patients with Type 2 diabetes mellitus (T2DM), adequate glycemic control is a critical factor in reducing long-term micro- and macro-vascular complications. Traditionally, the approach is to initiate monotherapy first, followed by combination therapy that targets two main defects in T2DM. Repaglinide, a rapidly acting insulin secretagog, stimulates insulin secretion via closure of ATP-dependent potassium channels on the cell membrane of β-cells. Repaglinide is ideally used at mealtime to reduce postprandial glucose levels, thus lowering the 24-h blood glucose profile and improving HbA1c levels. Metformin is an insulin sensitizer that effectively acts against insulin resistance, one of the predominant metabolic defects in T2DM. A combination of repaglinide and metformin is indicated as an adjunct to diet and exercise to improve glycemic control in adults with T2DM. When monotherapy with oral antidiabetic agents fails, combination therapy with repaglinide plus metformin has been demonstrated to be safe and effective in the treatment of T2DM.