Repaglinide/bedtime NPH insulin is comparable to twice-daily NPH insulin.

The combination of oral antidiabetic drugs and bedtime insulin is currently regarded as the first-line therapy in type 2 diabetes. Repaglinide is an insulin secretatogue with a rapid onset and relatively short duration of action (1–3) that was developed for prandial glucose regulation. The prandial glucose regulation strategy attempts to synchronize availability of insulin to the physiological need by stimulating endogenous insulin output in line with glucose intake. In type 2 diabetes, flexible prandial glucose regulation with repaglinide is well tolerated and safe, irrespective of the number of meals consumed per day (4,5). Repaglinide/NPH insulin combination has shown improved glycemic control in type 2 diabetic subjects inadequately controlled by sulfonylureas alone or in combination with metformin (6) or insulin monotherapy (7). However, no direct comparison between repaglinide and NPH insulin combination with NPH twice daily in type 2 diabetic subjects has been reported.