Role of prandial glucose regulators
Your article on diabetes care under the new contract (July 28) states that prandial glucose regulators are less effective than a sulphonylurea in lowering HbA1c. In fact repaglinide (NovoNorm)) has been shown to lower fasting glucose by up to 3.6mmol/l and HbA1c by up to 2.3 per cent relative to placebo in sulphonylurea-naive patients (Van Gaal et al, Diabetes Res Clin Pract 53, 2001:141-8).
In terms of maintaining HbA1c repaglinide is equivalent to glibenclamide (Landgraf R et al, Eur J Clin Pharm 1999; 55: 165-171) and gliclazide (data on file, Novo Nordisk study 047) but superior to glipzide (Madsbad S et al, Diabetic Medicine 2001; 18:395-401).
Contrary to creating compliance problems, repaglinide's dosing is intended to make it easy for patients to have a flexible lifestyle, used in a 'one-meal, one-dose; no-meal no-dose' basis up to four times a day.
Dr G Nelson
Senior Medical Adviser
Novo Nordisk, Crawley