Nateglinide decreases postprandial plasma ADMA levels in patients with newly diagnosed type 2 diabetes

Objective To investigate the effects of nateglinide versus acarbose on the levels of postprandial glucose, serum insulin, and plasma asymmetric dimethylarginine (ADMA) in patients with newly diagnosed type 2 diabetes. Methods A crossover trial of nateglinide and acarbose was conducted on 16 newly diagnosed type 2 diabetes patients during a period of 9 weeks. Plasma glucose, serum insulin, and plasma ADMA levels at fasting and after a standard meal were measured before and after treatment with both agents. Insulin resistance index was assessed using homeostasis model. Results The effects of 120 mg nateglinide and 50 mg acarbose on postprandial hyperglycemia in patients with type 2 diabetes were similar. Nateglinide could significantly stimulate early phase insulin release and was seemed to slightly improve insulin resistance (HOMA-IR 3.1±1.7 vs 2.8±1.9). Compared to acarbose, nateglinide remarkably decreased the postprandial levels of plasma ADMA[(0.75±0.22)vs(0.64±0.14)μmol/L]. Conclusions The results suggest that the reduction of postprandial ADMA level induced by nateglinide may be associated with the restoration of early phase insulin secretion and the improvement of insulin sensitivity and nateglinide may be better for improving post-meal epithelial dysfunction than acarbose.