Effect of the combination of mitiglinide and metformin on glycemic control in patients with type 2 diabetes mellitus

Aims/Introduction: Mitiglinide is the newest drug in the meglitinide family. It increases the early-phase insulin release through rapid association-dissociation kinetics in the pancreatic beta cells. The efficacy and safety of adding meglitinide to metformin monotherapy in patients with type 2 diabetes are unknown. Materials and Methods: We carried out a prospective, randomized, multicenter trial to assess the efficacy and safety of combined treatment with mitiglinide and metformin for patients with type 2 diabetes who showed inadequate glycemic control with metformin monotherapy. Subjects with glycated hemoglobin (HbA(1c)) > 7.0% after an 8-week metformin run-in phase were randomized to a 16-week trial phase with metformin plus mitiglinide (Met + Mit) or metformin plus placebo (Met + Pcb). Results: Compared with the Met + Pcb group, the Met + Mit group showed a greater reduction in HbA(1c) (-0.7 +/- 0.6% vs -0.4 +/- 0.7%, P = 0.002), fasting plasma glucose (-0.77 +/- 1.76 mmol/L vs -0.05 +/- 1.60 mmol/L, P = 0.015) and 2-h postprandial glucose (-3.76 +/- 3.57 mmol/L vs -0.84 +/- 3.07 mmol/L, P < 0.0001). The proportion of the patients who achieved the target HbA(1c) value of < 7% at the end of the study was also higher in the Met + Mit group than the Met + Pcb group (49.3% vs 28.8%, P = 0.016). There were no differences in the adverse event rates between groups. Conclusions: Combination therapy with metformin and mitiglinide is effective and safe for the treatment of patients with type 2 diabetes who have inadequate glycemic control with metformin monotherapy. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2010.00023.x, 2010)