Adding ranolazine to glimepiride treatment for patients with type 2 diabetes significantly lowered HbA1c over 24 weeks according to a study published in Diabetes, Obesity, and Metabolism

Ranolazine is an antianginal agent indicated for chronic angina that may be used with beta-blockers, nitrates, calcium channel blockers, ACE inhibitors, angiotensin receptor blockers, anti-platelet and lipid-lowering therapies. It has been associated with reduced HbA1c in prior angina clinical trials. 

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Jeremy Pettus, MD, from the University of California, San Diego, CA, and colleagues conducted two Phase 3 trials to assess the efficacy of ranolazine for glycemic control in patients with type 2 diabetes on metformin or glimepiride background therapy. The randomized, double-blind trials enrolled a total of 873 patients with type 2 diabetes to ranolazine 1000mg twice daily vs. placebo added to a glimepiride or metformin background therapy. The primary endpoint was change from baseline in HbA1c at Week 24. 

Adding ranolazine to glimepiride background therapy led to a 0.51% (least squares mean [LSM] 95% CI: 0.71, 0.32) decrease from baseline in HbA1c at Week 24 vs. placebo. The proportion of patients achieving an HbA1c <7% also doubled (27.1% vs.14.1%; P=0.001). Adding ranolazine to metformin background therapy did not lead a significant difference in the Week 24 HbA1c change from baseline (LSM difference -0.11%, 95% CI: -0.31, 0.1). 

A clear reduction in HbA1c over 24 weeks was seen in type 2 diabetes patients after they added ranolazine to glimepiride. However, researchers concluded it remains unclear “whether an effective regimen of ranolazine added to metformin for glycemic control can be identified.”

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