42


Chapter 2


Box 2.15 (cont.) Glucose-Lowering Medications for Type 2 Diabetes4,14 ○ Nateglinide (Starlix)


• Expected decrease decrease): 0.5%–1.5%


in HbA1c with monotherapy (unit


• Principal action: Stimulate insulin secretion from pancreatic beta cells


• Advantages: Decrease postprandial glucose excursion; dos- ing flexibility; moderate cost


• Disadvantages: Hypoglycemia; weight gain; frequent dosing schedule


• Usual dosage information:


○ Prandin: new diagnosis or HbA1c < 8%, 0.5 mg, 15–30 min before each meal; HbA1c > 8%, 1–2 mg, 15–30 min before each meal; increase dosage weekly until results are obtained; maximum 16 mg/d


○ Starlix: 60–120 mg before each meal Thiazolidinediones


• Examples: ○ Rosiglitazone (Avandia) ○ Pioglitazone (Actos) • Expected decrease


decrease): 0.5%–1.4% • Principal action: Improve peripheral insulin sensitivity


• Advantages: No hypoglycemia; durability; increase high-den- sity lipoprotein cholesterol levels; decrease triglyceride levels (pioglitazone); low cost


• Disadvantages: Weight gain; edema/heart failure; bone frac- tures; increase in low-density lipoprotein cholesterol (LDL-C) levels (rosiglitazone); potential increase in myocardial infarc- tion (rosiglitazone)


• Usual dosage information:


○ Actos: initially 15 or 30 mg/d; maximum (with or without food) 45 mg/d for monotherapy, 30 mg/d for combina- tion therapy


○ Avandia: initially 4 mg/d in single or divided doses; increase to 8 mg/d in 12 weeks, if needed; maximum (with or without food) 8 mg/d


Continued on next page.


in HbA1c with monotherapy


(unit


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