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Type 2s With A1c of 6.5% Benefit From Post-Meal Hyperglycemia Control With Nateglinide

Posted: Friday, November 23, 2007

There has always been the question as to whether tighter control, treating to normal A1cs In type 2 diabetic patients is beneficial. This study showed that even in Type 2s with good glycemic control, additional reduction of postprandial hyperglycemia with nateglinide prevents the progression of atherosclerosis.

Dr. Hirotaka Watada noted that although hemoglobin A1c (HbA1c) is regarded as a most important parameter representing blood glucose control, there has been no clear evidence showing the reduction of HbA1c reduces the incidence of cardiovascular disease. Recently, several data have demonstrated that postprandial hyperglycemia is a more reliable predictor for the onset of cardiovascular disease."

Dr. Watada and colleagues from Juntendo University School of Medicine, Tokyo, investigated the importance of postprandial hyperglycemia on the progression of atherosclerosis in 78 type 2 diabetic patients who had already achieved HbA1c below 6.5%.

They randomly assigned 38 of the patients to nateglinide and 40 to no treatment (control group). "Nateglinide," Dr. Watada noted, "is a short acting drug to enhance insulin secretion and, when taken just before each meal, effectively reduces postprandial hyperglycemia but not fasting hyperglycemia, making this drug convenient to investigate the importance of postprandial hyperglycemia."

After 12 months, untreated controls experienced a significant increase in HbA1c and carotid intima-media thickness (IMT) indicating progression of atherosclerosis. In contrast, nateglinide treatment led to a significant reduction in HbA1c and a modest decrease in carotid IMT.

The change from baseline in HbA1c at 1 year was -0.17% in the nateglinide arm and +0.12% in the control arm (p < 0.001), while the change from baseline in carotid IMT was -0.017 and +0.024 mm/year, respectively, (p = 0.0064).

In summary, the investigators write, "In type 2 diabetic patients with good glycemic control, further strict glycemic control by nateglinide results in regression of carotid intima-media thickness."

Source: Diabetes In Control: Arterioscler Thromb Vasc Biol 2007;27:2456-2462