Switch from metformin monotherapy to bitherapy with metformin and repaglinide to achieve glycated haemoglobin target in type 2 diabetes (REPAMET Study)

AimTo evaluate glycaemic control, including HbA1c, following the addition of repaglinide to monotherapy with metformin as part of routine follow-up of adult type 2 diabetes patients no longer controlled with metformin (i.e. in secondary monotherapy failure).Subjects and methodsProspective, open-label, observational study in primary care setting, consisting of 2 visits (metformin/repaglinide bitherapy initiation and follow-up within 10–20 weeks), with analysis of HbA1c levels, fasting glycaemia, body mass index and hypoglycaemic episodes within past month.Results2171 patients were included, with average diabetes duration (mean ± 1 SD) 7 ± 6 years, BMI 30.2 ± 5.5 kg/m2, and fasting glucose at entry 179 ± 50 mg/dl. Mean decrements in fasting glycaemia and HbA1c between visits rose with increasing HbA1c at Visit 1. The proportion of patients with controlled fasting glycaemia increased by an absolute 40% for therapeutic goal set at 90–130 mg/dl. Treatment goal (HbA1c < 7.0%) was achieved by 38% of patients at Visit 2, with number of patients with HbA1c ≥ 8.0% decreasing by an absolute 34%. The percentage of patients experiencing ≥1 hypoglycaemic episode(s) within the previous month marginally rose from 5.0 to 5.6%.ConclusionCombining metformin with repaglinide appears a safe and effective therapeutic option once monotherapy with metformin is no longer adequate in adult patients with type 2 diabetes followed in a primary care setting.