The anti-anginal drug ranolazine significantly reduces both fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) when added to antidiabetic therapy in patients with poorly controlled Type 2 diabetes, analysis of MERLIN-TIMI 36 data indicate.

Previous results from the MERLIN-TIMI 36 (Metabolic Efficiency with Ranolazine for Less Ischemia in Non??”ST-Elevation Acute Coronary Syndromes??”Thrombolysis in Myocardial Infarction 36) trial, reported by MedWire News, demonstrated that ranolazine has a beneficial effect on HbA1c levels in patients with and without Type 2 diabetes.

The current study assessed the effects of ranolazine on HbA1c and FPG in participants of the MERLIN-TIMI 36 trial with Type 2 diabetes and a high HbA1c or FPG at randomization.

In the original study, 6560 patients with acute coronary syndrome were assigned to receive placebo or ranolazine 1000 mg twice daily (intravenous infusion followed by oral administration). In total, 770 of the participants who were treated with placebo and 707 who were treated with ranolazine were diabetic.

Writing in the journal Diabetes Care, the team report that diabetic patients with a baseline HbA1c of 8% or more (n=171) who were treated with ranolazine had a significant placebo-corrected decrease in HbA1c of 0.59%. This reduction amounted to approximately twice that achieved by patients with an initial HbA1c of 6??”8%.

Patients with an FPG of 150??”400 mg/dl at randomization (n=131), indicative of marked hyperglycemia, who were treated with ranolazine had a significant placebo-corrected reduction in FPG of 25.7 mg/dl. However, patients with normal to moderate fasting hyperglycemia (FPG below 150 mg/dl) treated with ranolazine had no significant change in FPG over the study period, compared with those treated with placebo.

“These results indicate that the previously reported lowering of HbA1c by ranolazine is positively correlated with HbA1c levels at randomization and is associated with a reduction in FPG in patients with hyperglycemia,” write the authors.

They conclude: “The mechanism of action of ranolazine to lower FPG and HbA1c is currently being investigated, however preliminary data from studies using rat and human pancreatic islets suggests that ranolazine may promote glucose-stimulated insulin secretion.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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MERLIN-TIMI confirms favorable effects of ranolazine on HbA1c