Meglitinides target beta-cells and increase insulin secretion, much like sulfonylureas but act on a different target. This drug class must be given with meals otherwise only small amounts of insulin are released when blood sugar levels are lower between meals.

Drugs in this class include mitiglinide, nateglinide and repaglinide.

• MITIGLINIDE

  Tradename (s)	Glufast®
  Company(ies)	Kissei Pharmaceuticals / Takeda
  Available doses	5 mg and 10 mg
  Dose per day	with each meal
  Side-effects	hypoglycemia
  Elimination half-life
  Metabolism
  US patent status
  US FDA status	not approved but in clinical trials
  EMEA status	not approved
  Indication
  Improvement of postprandial plasma glucose transition in patients with type 2 diabetes mellitus - combination therapy with insulin sensitizer -
  Comments
  Launched in Japan in May 2004 Elixir Pharmaceuticals is presently conducting clinical trials to seek regulatory approval in the US under the tradename Glinsuna™.

• NATEGLINIDE

  Tradename(s)	Starlix®
  Company(ies)	Novartis Pharma
  Available doses	60 mg and 120 mg
  Dose per day	with each meal
  Side-effects	hypoglycemia
  Elimination half-life	1.5 hours
  Metabolism	metabolized by the mixed-function oxidase system
  US patent status
  US FDA status	approved December 2000
  EMEA status	approved April 2001
  Indication
  Starlix® (nateglinide) is indicated as monotherapy to lower blood glucose in patients with Type 2 diabetes (non-insulin dependent diabetes mellitus, NIDDM) whose hyperglycemia cannot be adequately controlled by diet and physical exercise and who have not been chronically treated with other antidiabetic agents. Starlix is also indicated for use in combination with metformin or a thiazolidinedione. In patients whose hyperglycemia is inadequately controlled with metformin or after a therapeutic response to a thiazolidinedione, Starlix may be added to, but not substituted for, those drugs.

• REPAGLINIDE

  Tradename(s)	Prandin®, GlucoNorm®, NovoNorm®
  Company(ies)	Novo Nordisk
  Available doses	0.5 mg, 1 mg and 2 mg
  Dose per day	with each meal
  Side-effects	hypoglycemia
  Elimination half-life	1 hour
  Metabolism	metabolized by oxidative biotransformation
  US patent status	expires in 2009
  US FDA status	approved December 1997
  EMEA status	approved August 1998
  Indication
  Prandin® is indicated as an adjunct to diet and exercise to lower the blood glucose in patients with type 2 diabetes mellitus (NIDDM) whose hyperglycemia cannot be controlled satisfactorily by diet and exercise alone. Prandin® is also indicated for combination therapy use (with metformin or thiazolidinediones) to lower blood glucose in patients whose hyperglycemia cannot be controlled by diet and exercise plus monotherapy with any of the following agents: metformin, sulfonylureas, repaglinide, or thiazolidinediones.
  Comments
  NovoNordisk reported sales of DKK 1,984 million in 2006 and DDK 2,149 million in 2007.(DKK=Danish kroner)