Abstract: OBJECTIVE To compare the effects of pioglitazone, metformin and repaglinide on blood glucose, serum uric acid and renal function in recent-onset type 2 diabetes. METHODS Seventy-five recent-onset type 2 diabetes with hyperuricemia were analyzed. Fasting glucose, 2-hour glucose, glycation hemoglobin(HbA1c), serum uric acid, microalbuminuria(MAU), blood urea nitrogen(BUN), serum creatinine(Cr), total cholesterol(TC) and triglyceride(TG) were measured before and after 12 weeks of treatment with pioglitazone(n=25), repaglinide(n=25) or metformin(n=25). RESULTS Fasting glucose, 2-hour glucose, HbA1c, serum uric acid, MAU, BUN, Cr, TC and TG decreased significantly at 12 weeks in patients receiving pioglitazone(P<0.05). Fasting glucose, 2-hour glucose and HbA1c decreased significantly at 12 weeks in patients receiving repaglinide(P<0.05). Fasting glucose, 2-hour glucose, HbA1c, MAU, TC and TG decreased significantly at 12 weeks in patients receiving metformin(P<0.05). At 12 weeks, the repaglinide group had lower fasting glucose, 2-hour glucose and HbA1c, than the pioglitazone group and the metformin group(P<0.05). The pioglitazone group had lower serum uric acid , BUN and Cr, than the repaglinide group and the metformin group(P<0.05). The pioglitazone group had lower MAU than the metformin group(P<0.05). CONCLUSION Repaglinide lead to a decrease on blood glucose decrease; pioglitazone lead to a decrease on serum uric acid, and improved renal function. For recent-onset type 2 diabetes who also have diabetic nephropathy, hyperuricemia or gout, pioglitazone is a better choice.