Glinides and glitazones in people with diabetes

Various medicines are available to treat type 2 diabetes mellitus. This summary report compares the safety and efficacy of the glinide and glitazone active substance group with all the other diabetes medicines available in Switzerland. This comparison was based on various reviews investigating similar issues and on literature searches. The results provide a basis for a decision on whether the costs of treatment with these active substances should still be only partly reimbursed in the future.

Glinides (repaglinide and nateglinide) and glitazones (pioglitazone) are taken as tablets for reducing blood glucose levels in type 2 diabetes. Compared with other active substances, repaglinide and nateglinide showed no significant differences in safety in terms of undesirable side effects such as hypoglycaemia, blood pressure or weight change, or in efficacy in terms of reduced mortality or treatment complications. This also applies in the main for pioglitazone, with the difference that this medicine proved to be slightly more effective. It was also associated with slightly more side effects and risks. The evidence as to whether and to what extent glinides and glitazones perform better or worse than other medicines is limited, since the studies that were reviewed varied hugely and are therefore not universally comparable.

The report concludes that as regards efficacy and side effects, there is virtually no difference between the three active substances investigated and other widely used treatments. It simply recommends taking greater account of the risks associated with pioglitazone when deciding whether or not to prescribe it.