Comparison of Metformin Versus Repaglinide Monotherapy in the Treatment of New-Onset Type 2 Diabetes Mellitus

Waseem  Ahmad; Shahzad Alam  Khan; Muhammad  Sajid; Sohail  Safdar; Ambreen Nadeem  Khan

doi:10.54112/bcsrj.v6i6.2078

Authors

Waseem Ahmad Department of Medicine, Nishtar Hospital, Multan, Pakistan
Shahzad Alam Khan Department of Medicine, Nishtar Hospital, Multan, Pakistan
Muhammad Sajid Department of Endocrinology, Nishtar Hospital, Multan, Pakistan
Sohail Safdar Department of Medicine, Nishtar Hospital, Multan, Pakistan
Ambreen Nadeem Khan Department of Endocrinology, Nishtar Hospital, Multan, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i6.2078

Keywords:

Type 2 diabetes mellitus, Repaglinide, Metformin, Glycated Hemoglobin

Abstract

Poorly controlled diabetes has devastating effects on the heart, kidneys, eyes, nerves, and blood vessels. This study aimed to compare mean HbA1c values after 3 months of initiating metformin versus repaglinide monotherapy in treating new-onset type 2 diabetes mellitus. Methods: This open-label, parallel-group, randomized controlled trial was conducted at the Department of Medicine, Nishtar Hospital, Multan, from 1st February 2025 to 31st May 2025. Sixty newly diagnosed T2DM patients aged 20–60 years were enrolled after informed consent. Baseline HbA1c was measured, and patients were randomly assigned using a lottery method with sealed opaque envelopes. Group A received Repaglinide monotherapy (0.75–1.5 mg/day), and Group B used Metformin (750–1500 mg/day). Serum sugar was monitored daily and doses adjusted in the first week. All patients received diet and lifestyle advice with monthly follow-up for three months. Compliance was monitored with a checklist. HbA1c was measured again at three months. Data was analysed through SPSS version 23. Mean HbA1c between the groups was compared using a t-test at the 5% significance level. Results: The mean age was 51.8±6.6 years, and 60% were male. Obesity, smoking, and hypertension were found in 51.7%, 41.7%, and 70% respectively. Mean HbA1c decreased from 8.4 ± 0.5 to 6.1 ± 0.6. The Repaglinide group had higher baseline HbA1c but lower post-treatment HbA1c (5.6 ± 0.3 vs. 6.6 ± 0.3, p-value < 0.01) than the Metformin group. Conclusion: Repaglinide monotherapy was more effective than Metformin in reducing HbA1c over three months, supporting use in early T2DM management.

Downloads

Download data is not yet available.

References

Xu B, Li S, Kang B, Zhou J. The current role of sodium-glucose cotransporter two inhibitors in type 2 diabetes mellitus management. Cardiovasc Diabetol. 2022;21(1):83. https://doi.org/10.1186/s12933-022-01512-w

Jehangir F, Khan T, Aziz Z, Giani A, Adnan T. Fasting in Ramadan is safe for individuals suffering from type 2 diabetes mellitus in Pakistan. Pak J Med Dent. 2020;9(3):25-31. https://doi.org/10.36283/PJMD9-3/006

Riquelme-Gallego B, García-Molina L, Cano-Ibáñez N, Andújar-Vera F, González-Salvatierra S, García-Fontana C, et al. Undercarboxylated osteocalcin: A promising target for early Diagnosis of cardiovascular and glycemic disorders in patients with metabolic syndrome: a pilot study. Nutrients. 2022;14(14):2991. https://doi.org/10.3390/nu14142991

Ma H, Yu G, Wang Z, Zhou P, Lv W. Association between dysglycemia and mortality by diabetes status and risk factors of dysglycemia in critically ill patients: a retrospective study. Acta Diabetol. 2021;59(4):461-70. https://doi.org/10.1007/s00592-021-01818-3

Kim JY, Kim NH. Initial combination therapy in type 2 diabetes. Endocrinol Metab. 2024;39(1):23-32. https://doi.org/10.3803/EnM.2023.1816

Baker C, Retzik-Stahr C, Singh V, Plomondon R, Anderson V, Rasouli N. Should metformin remain the first-line therapy for treatment of type 2 diabetes? Ther Adv Endocrinol Metab. 2021;12:2042018820980225. https://doi.org/10.1177/2042018820980225

Li J, Zhao M, Liu M, Tang K, Sun G. Clinical effects of insulin glargine combined with repaglinide in the treatment of type 2 diabetes. Am J Transl Res. 2021;13(11):13010-6. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8661186/

Younas A, Riaz J, Chughtai T, Maqsood H, Younus S, Qasim M, et al. Comparison of metformin and repaglinide monotherapy in the treatment of new-onset type 2 diabetes mellitus. Cureus. 2021;13(1):e13045. https://doi.org/10.7759/cureus.13045

Muhammad DD, Javed M, Iftikhar M. Type 2 diabetes mellitus: comparison of efficacy of repaglinide and metformin in the treatment of new onset type 2 diabetes mellitus. Professional Med J. 2019;26(4):539-44. https://doi.org/10.29309/TPMJ/2019.26.04.2876

Ma J, Liu L, Wu P, Liao Y, Tao T, Liu W. Comparison of metformin and repaglinide monotherapy in the treatment of new onset type 2 diabetes mellitus in China. Diabetes Res. 2014;2014:294017. https://doi.org/10.1155/2014/294017

Sandholm N, Dahlström EH, Groop PH. Genetic and epigenetic background of diabetic kidney disease. Front Endocrinol. 2023;14:1163001. https://doi.org/10.3389/fendo.2023.1163001

Ke C, Narayan KV, Chan JC, Jha P, Shah BR. Pathophysiology, phenotypes, and management of type 2 diabetes mellitus in Indian and Chinese populations. Nat Rev Endocrinol. 2022;18(7):413-32. https://doi.org/10.1038/s41574-022-00669-4.

Shi Q, Nong K, Vandvik PO, Guyatt GH, Schnell O, Rydén L, et al. Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials. BMJ. 2023;381:e074068. https://doi.org/10.1136/bmj-2022-074068

Fang FS, Gong YP, Li CL, Li J, Tian H, Huang W, et al. Comparison of repaglinide and metformin monotherapy as an initial therapy in Chinese patients with newly diagnosed type 2 diabetes mellitus. Eur J Endocrinol. 2014;170(6):901-8. https://doi.org/10.1530/EJE-14-0052

Lund SS, Tarnow L, Stehouwer CD, Schalkwijk CG, Teerlink T, Gram J, et al. Impact of metformin versus repaglinide on non-glycaemic cardiovascular risk markers related to inflammation and endothelial dysfunction in non-obese patients with type 2 diabetes. Eur J Endocrinol. 2008;158(5):631-41. https://doi.org/10.1530/EJE-07-0815

Haggar MS, Ntaganda JM, Adoum AH. A mathematical Model for investigating the therapeutic response of repaglinide and metformin in type 2 diabetes patients. Far East J Dyn Syst. 2025;38(1):107-25. https://doi.org/10.17654/0972111825005

Chen Y, Jiang Q, Xing X, Yuan T, Li P. Clinical research progress on β-cell dysfunction in T2DM development in the Chinese population. Rev Endocr Metab Disord. 2025;26(1):31-53. https://doi.org/10.1007/s11154-024-09914-9

Mohajan D, Mohajan HK. Oral hypoglycaemic agents: non-insulin medications for type 2 diabetes patients. Innov Sci Technol. 2024;3(1):23-31. Available from: https://www.paradigmpress.org/ist/article/view/958.

Mahdi K, AL-Hady FA. Effect of repaglinide and metformin as anti-diabetic drugs on epididymal sperm parameters. Ann Rom Soc Cell Biol. 2021;25(6):11864-87

Chawla MS, Sahoo AK, Ramanathan B, Dhand S, Parikh D, Rathod D, et al. IDF21-0453 Phase-3 active control trial to evaluate the safety and efficacy of repaglinide plus voglibose combination in T2D patients. Diabetes Res Clin Pract. 2022;186:109545. https://doi.org/10.1016/j.diabres.2022.109545

Jain AK, Sahu P, Mishra K, Jain SK. Repaglinide and metformin-loaded Amberlite resin-based floating microspheres for the effective management of type 2 diabetes. Curr Drug Deliv. 2021;18(5):654-68. https://doi.org/10.2174/1567201817666201026105611.

Omori K, Nomoto H, Nakamura A, Takase T, Cho KY, Ono K, et al. Reduction in glucose fluctuations in elderly patients with type 2 diabetes using repaglinide: a randomized controlled trial of repaglinide vs sulfonylurea. J Diabetes Investig. 2018;10(2):367-74. https://doi.org/10.1111/jdi.12889.