Repaglinide equals insulin for glucose control in cystic-fibrosis-related diabetes
medwireNews: The oral antidiabetic drug repaglinide controls blood glucose levels as effectively as insulin in patients with newly diagnosed cystic-fibrosis-related diabetes, study findings indicate.
Manfred Ballmann (University Medicine Rostock, Germany) and colleagues say that “repaglinide represents an alternative treatment to insulin for patients with newly diagnosed asymptomatic cystic-fibrosis- related diabetes” that could reduce the burden of care in patients already undergoing complex and demanding therapy.
For their multicenter trial, Ballmann and team randomly assigned 75 patients, aged 10 years and older, with cystic fibrosis and newly diagnosed diabetes to receive repaglinide (n=34) or insulin (n=41) for 2 years.
The researchers note that they chose repaglinide “because of its favourable side-effect profile in patients with cystic fibrosis compared with other oral antidiabetic drugs.”
At 2 years, glycemic control did not differ significantly between the 30 patients in the repaglinide group who were eligible for the modified intention-to-treat analysis and the 37 eligible patients treated with insulin.
Specifically, glycated hemoglobin (HbA1c) concentration fell from 6.4% baseline to 6.2% at 2 years with repaglinide and increased from 6.6% to 6.8% with insulin.
Ballmann et al point out that HbA1c concentrations “are often misleadingly low” in patients with cystic fibrosis “meaning that the antidiabetic treatment target in patients with cystic-fibrosis-related diabetes is frequently less than 7.0%.”
In this study, 77% of patients in the repaglinide group and 70% of those in the insulin group had an HbA1c level below 7.0% at baseline. The corresponding proportions at 2 years were 86% and 74%, respectively.
The team also report that BMI and measures of lung function were comparable between the two groups at 2 years.
In addition, adverse event rates were comparable with both treatments, and were most commonly pulmonary events. These represented 40% of 107 adverse events in the repaglinide group and 45% of 133 events in the insulin group.
Symptomatic hypoglycemia was reported by 22 patients in each group, with no cases resulting in coma and only one patient in each group needing help by another person.
Ballmann and co-authors conclude: “We recommend that treatment guidelines include repaglinide as an option for early-stage cystic-fibrosis-related diabetes.”
Commenting on the findings in The Lancet Diabetes and Endocrinology, Antionette Moran, from the University of Minnesota in Minneapolis, USA, agrees that the data “suggest that oral antidiabetes drugs could at least provide a bridge to insulin therapy in the early stages of cystic-fibrosis-related diabetes.”
However, she thinks that the results should be interpreted with caution because they could indicate that “that the two drugs are equally effective treatments for early cystic-fibrosis-related diabetes,” but could also mean that “the insulin doses were insufficient to effect change.”
Moran therefore concludes: “For now, I believe that the jury is still out on the use of oral antidiabetes drugs for the treatment of cystic-fibrosis-related diabetes.”
By Laura Cowen
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