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Repaglinide

Classification: A

Drug products: NovoNorm®, Repaglinid Actavis, Repaglinid Arrow, Repaglinid Sandoz, Repaglinid STADA, Repaglinide Accord, Repaglinide Krka, Repaglinide Teva

ATC code: A10BX02

Substances: repaglinide

Summary

No clinically relevant sex differences have been described. A retrospective cohort study has shown a possible higher risk of hospitalized heart failure for women.
Some studies indicate that women have a higher risk of hypoglycemia during antidiabetic treatment than men.

Additional information

Pharmacokinetics and dosing

No studies with a clinically relevant sex analysis regarding the pharmacokinetics of repaglinide have been found.

Effects

No studies with a clinically relevant sex analysis regarding the effect of repaglinide have been found.

Adverse effects

In a retrospective cohort study from Taiwan including patients with type 2 diabetes treated with glinide (meglitinide/repaglinide) (14,357 men, 11,281 women) a higher risk of hospitalized heart failure was found for women (men: adjusted HR 1.26; 95%CI 0.95-1.68; women: adjusted HR 1.88; 95%CI 1.39-2.55) [6].The ACCORD study (Action to Control Cardiovascular Risk in Diabetes) was a randomized, controlled trial designed to test the effect of intensive glucose control compared with standard control on cardiovascular outcomes in patients with type 2 diabetes. The study showed that women had a higher risk of hypoglycemia than men regardless of treatment [1].Analyses of other insulins have shown a higher risk for women to have hypoglycemic events [7-11].

Reproductive health issues

Oral contraceptives may reduce the hypoglycaemic effect of repaglinide [12]. Regarding drug-drug interactions aspects, please consult Janusmed Interactions (in Swedish, Janusmed interaktioner).

Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).

Other information

Two observational studies from the 1990’s (43 men, 374 women) reported intentional insulin omission among 1/3 of women to control their weight [2,3].

In a retrospective study in 124 women, peri-menstrual changes in self-reported glucose concentrations were found in 61%. Use of oral contraceptives did not diminish variability in blood glucose [4]. In another study based on questionnaires (406 women) 67% of the participants reported changes in blood glucose levels or glycosuria pre-menstrually and 70% during the menstrual phase. Those with more cravings had larger elevations in blood glucose levels suggesting that giving in to cravings might cause the changes [5].

Updated: 2020-03-20

Date of litterature search: 2020-03-03

References

  1. Miller ME, Bonds DE, Gerstein HC, Seaquist ER, Bergenstal RM, Calles-Escandon J et al. The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD study. BMJ. 2010;340:b5444. PubMed
  2. Polonsky WH, Anderson BJ, Lohrer PA, Aponte JE, Jacobson AM, Cole CF. Insulin omission in women with IDDM. Diabetes Care. 1994;17:1178-85. PubMed
  3. Bryden KS, Neil A, Mayou RA, Peveler RC, Fairburn CG, Dunger DB. Eating habits, body weight, and insulin misuse A longitudinal study of teenagers and young adults with type 1 diabetes. Diabetes Care. 1999;22:1956-60. PubMed
  4. Lunt H, Brown LJ. Self-reported changes in capillary glucose and insulin requirements during the menstrual cycle. Diabet Med. 1996;13:525-30. PubMed
  5. Cawood EH, Bancroft J, Steel JM. Perimenstrual symptoms in women with diabetes mellitus and the relationship to diabetic control. Diabet Med. 1993;10:444-8. PubMed
  6. Lee YC, Chang CH, Dong YH, Lin JW, Wu LC, Hwang JS et al. Comparing the risks of hospitalized heart failure associated with glinide, sulfonylurea, and acarbose use in type 2 diabetes: A nationwide study. Int J Cardiol. 2017;228:1007-1014. PubMed
  7. Seufert J, Brath H, Pscherer S, Borck A, Bramlage P, Siegmund T. Composite efficacy parameters and predictors of hypoglycaemia in basal-plus insulin therapy--a combined analysis of 713 type 2 diabetic patients. Diabetes Obes Metab. 2014;16:248-54. PubMed
  8. Kautzky-Willer A, Kosi L, Lin J, Mihaljevic R. Gender-based differences in glycaemic control and hypoglycaemia prevalence in patients with type 2 diabetes: results from patient-level pooled data of six randomized controlled trials. Diabetes Obes Metab. 2015;17:533-40. PubMed
  9. McGill JB, Vlajnic A, Knutsen PG, Recklein C, Rimler M, Fisher SJ. Effect of gender on treatment outcomes in type 2 diabetes mellitus. Diabetes Res Clin Pract. 2013;102:167-74. PubMed
  10. Owens DR, Bolli GB, Charbonnel B, Haak T, Landgraf W, Porcellati F et al. Effects of age, gender, and body mass index on efficacy and hypoglycaemia outcomes across treat-to-target trials with insulin glargine 100 U/mL added to oral antidiabetes agents in type 2 diabetes. Diabetes Obes Metab. 2017;19:1546-1554. PubMed
  11. Vlckova V, Cornelius V, Kasliwal R, Wilton L, Shakir SA. Hypoglycaemia with oral antidiabetic drugs: results from prescription-event monitoring cohorts of rosiglitazone, pioglitazone, nateglinide and repaglinide. Drug Saf. 2009;32(5):409-18. PubMed
  12. NovoNorm (repaglinide). Summary of Product Characteristics. European Medicines Agency (EMA) [updated 2017-09-28, cited 2020-03-03].
  13. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2019 [cited 2020-03-10.] länk

Authors: Emelie Elfving, Linnéa Karlsson Lind

Reviewed by: Mia von Euler, Carl-Olav Stiller

Approved by: Karin Schenck-Gustafsson