Comparison of the Efficacy of Repaglinide versus the Combination of Mitiglinide and Voglibose on Glycemic Variability in Japanese Patients with Type 2 Diabetes

Background: Glycemic variability is a risk factor for total death and cardiovascular events. There are no obvious guidelines for the direct treatment of glycemic variability, but it can be improved with the treatment of postprandial hyperglycemia. Objective: We compared the effect of repaglinide versus the combination of mitiglinide and voglibose, used to improve postprandial hyperglycemia, on glycemic variability in Japanese patients with type 2 diabetes. Methods: We performed an open-label randomized cross-over trial between April 2016 and April 2018. Patients with type 2 diabetes who were admitted to our hospital were enrolled in our study (n = 12). Glycemic variability was assessed using a continuous glucose monitoring system. Results: The average glucose level of the repaglinide phase (146.1 +/- 20.7 mg/dl) and the combination of mitiglinide and voglibose phase (132.3 +/- 19.8 mg/dl) were similar (P = 0.10). The standard division (P = 0.0005), coefficient of variation (P = 0.006), and mean amplitude of glycemic excursion (P = 0.002) of glucose were lower in the combination of mitiglinide and voglibose phase than in the repaglinide phase. Conclusion: Treatment with the combination of mitiglinide and voglibose might be more effective than repaglinide for the improvement of glycemic variability.