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Las glinidas representan una nueva familia de secretadores de insulina, químicamente heterogénea, caracterizados por un inicio de acción rápido y de corta duración. La repaglinida posee un efecto hipoglucemiante superponible al de las sulfonilureas convencionales. Algunos estudios indican un descenso en el riesgo de hipoglucemias, sobre todo nocturnas, y en el caso de omisión de una comida principal. Este fármaco parece especialmente útil en estadios iniciales de la diabetes tipo 2 y en combinación con metformina. Puede emplearse en pacientes con insuficiencia renal moderada y está contraindicada en caso de insuficiencia hepática grave. La nateglinida presenta una menor duración de acción y un peor control de la hemoglobina glucosilada que la repaglinida. Algunos estudios experimentales sugieren que las glinidas pueden preservar mejor que las sulfonilureas la función de la célula beta pancreática y que el mejor control de las excursiones glucémicas posprandiales podría tener un efecto beneficioso en la reducción del riesgo cardiovascular de estos pacientes.
Palabras clave:
Repaglinida
Nateglinida
Diabetes mellitus tipo 2
Glucemia posprandial
Uso terapéutico
Glinides are a new, chemically heterogeneous class of insulin-secreting agents characterized by rapid onset and short duration of action. Repaglinide has an equivalent hypoglycemic effect to conventional sulfonylureas. Several studies have reported a decreased risk of hypoglycemias, particularly nocturnal hypoglycemic episodes or those occurring after a main meal has been missed. This drug seems to be particularly useful in the early stages of type 2 diabetes or in combination with metformin. Repaglinide can be used in patients with moderate renal insufficiency, but is contraindicated in severe hepatic dysfunction. Nateglinide has a shorter duration of action and is less effective in HbA1c control than repaglinide. Several experimental studies have suggested that glinides could be more effective in preserving beta-cell function than sulfonylureas, and that improvement of postprandial glucose levels could exert a protective cardiovascular effect.
Key words:
Repaglinide
Nateglinide
Type 2 diabetes mellitus
Postprandial glycemia
Therapeutic use
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