A trial carried out in Europe suggests that repaglinide tablets are as effective and safe as insulin in treating people with newly diagnosed cystic-fibrosis-related diabetes (CFRD).
Diabetes can result from the genetic condition cystic fibrosis if the pancreas becomes scarred or if insulin resistance develops because of steroid use.
The most common medication to date is for people with CFRD to use insulin to manage their blood sugar. However, the new trial suggests that the type 2 diabetes medication repaglinide may be more effective.
Repaglinide is in a class of drugs called glinides which stimulate the pancreas to release more insulin. This helps lower blood sugar but also increases the likelihood of weight gain. Because of this, glinides are falling out of favour as a drug to treat type 2 diabetes. With CFRD, patients typically struggle to put weight on and so the weight gain associated with insulin and glinides is less likely to occur.
The trial tested the effects of repaglinide against insulin over a 24-month period. Patients were randomly assigned to one of the treatments. 75 patients were enrolled and 67 were included in the study analysis.
The results showed that difference in HbA1c was similar in both groups. HbA1c increased on average by a small amount 1.7 mmol/mol (0.2%) for repaglinide users and reduced by 2.7 mmol/mol (0.2%) in the insulin users. The insulin users therefore had better HbA1c by 4.4 mmol/mol (0.4%) than repaglinide users. However, the difference was not statistically different.
Effects on safety were similar in repaglinide and insulin. As the effects on HbA1c were roughly similar, the fact that tablets are easier to take than insulin suggests that repaglinide may be a better option for some patients. Patients that take well to insulin may find that insulin is the option for them if they prefer the greater level of diabetes control it gives them.
This two-year study gives a good idea of effectiveness, however, more studies will be useful to assess whether there are other benefits and disadvantages of tablets over insulin aside from HbA1c and general safety.
The trial is published online for The Lancet Diabetes &Endocrinology journal.

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