A 66-year-old man with type 2 diabetes, eGFR 25 mL/min/1.73 m², has isolated postprandial hyperglycaemia despite basal insulin. Which oral agent is most suitable for controlling his meal-related glucose excursions?
- A Repaglinide ✓
- B Pioglitazone
- C Glibenclamide
- D Canagliflozin
Correct answer: A. Repaglinide
Explanation
Repaglinide is a meglitinide that closes beta cell K-ATP channels like a sulfonylurea but has a very short half-life of about 1 hour, so it is taken 0 to 30 minutes before meals specifically to blunt postprandial peaks. It is metabolised by the liver to inactive products and is considered safe in significant renal impairment, unlike glibenclamide whose active metabolites accumulate. Pioglitazone causes fluid retention and is undesirable here, and canagliflozin loses efficacy below an eGFR of about 30 mL/min/1.73 m².
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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