The Meglitinides are a relatively new and promising group of oral anti-diabetic drugs. They are currently indicated in patients with Type 2 Diabetes who are intolerant of the first-line agents - the Biguanides and the Sulfonylureas.
Their mechanism of action is similar to that of the Sulfonylureas though they act at a distinct binding site. They are insulin secretagogues and therefore true hypoglycaemics.
These drugs are more potent than the Biguanides or Sulfonylureas and act more quickly. They should be administered immediately before meals. Hypoglycemia can result from overdose, inappropriate meal-timing or in patients with impaired drug clearance. Though weight gain has been reported; Meglitinides have not been associated with the nastier potential effects of Sulfonylureas such as agranulocytosis and aplastic anaemia.
Two Meglitinides are now available - Repaglinide (derived from Benzoic acid) and Nateglinide (derived from D-phenylalanine). Nateglinide is faster acting and less sensitive to impaired renal function. It may be particularly useful to control post-prandial glucose spikes in patients with type 2 Diabetes.
British National Formulary v.54
Brunton et al. Goodman & Gilman's The Pharmacological Basis of Therapeutics 11th edition.