The meglitinides offer an opportunity to target specifically the postprandial hyperglycemia that occurs commonly in patients with type 2 diabetes. Their rapid onset and short duration of action leads to more “physiological” release of insulin and partially restores the pattern of postprandial insulin secretion that is defective in type 2 diabetes mellitus. This potentially allows tighter glycemic control while reducing the risk of hypoglycemia. As prandial glucose regulators they allow flexible dosing such that a tablet need only be taken before a patient has a meal. Repaglinide in particular has been shown to reduce HbA_1c and is well-tolerated by patients both as monotherapy and in combination with other agents. It appears to have some advantages from head-to-head studies with sulfonylureas. Nateglinide appears to produce a faster early-phase insulin response that gives it the potential to produce less hypoglycemia, but randomized controlled trials in comparison with sulfonylureas are lacking. Both agents are more expensive than sulfonylureas. Formal data regarding cost-effectiveness are not currently available. However, their flexible administration may be of benefit in certain subgroups such as shift-workers and those with flexible lifestyles. Efficacy in early diabetes and impaired glucose tolerance is currently being investigated. The ability to flexibly dose with these agents makes them useful in patients with flexible lifestyles. Macrovascular and microvascular outcome data for the meglitinides are awaited.