Abstract
To evaluate long-term efficacy and safety, mitiglinide was administered over 12 months in 28 diabetic patients receiving maintenance hemodialysis(HD) (five : no previous medication with antidiabetic drugs (ADs), 23 : switch from other ADs). Mitiglinide improved glycemic control in patients without previous medication and those switching from nateglinide, low-dose insulin and voglibose, but did not improve glycemic control in many of those who had been treated with sulfonylurea derivatives. We categorized all subjects into three groups according to their glycoalbumin (GA) level at the end of the observation periodv (median 26 months, range 15-28 months) ;Good:GA≤21% (n=13), Fair:21<GA<24% (n=7), and Poor:GA≥24% (n=8). The changes in GA level (start to end point) ranged from 20.8±2.6 to 18.3±1.8%, from 23.1±2.4 to 22.8±0.8%, from 24.3±4.1 to 27.2±3.5% in the respective groups. A daily dosage of mitiglinide was significantly larger in the Poor group than the Good group (25.5±5.1 and 13.6±9.7mg/day, respectively;p<0.05). There were no significant differences in age, duration of diabetes and HD, BMI and previous types of treatment among the three groups. Mild hypoglycemia was found mainly after HD in 7 of 13 cases in the Good group, 3 of 7 cases in the Fair group, 4 of 8 cases in the Poor group, but there were no cases showing severe hypoglycemia. These findings indicate that mitiglinide is effectively and can be safely used for diabetic patients on maintenance HD, if careful attention is paid to hypoglycemia.
