Consensus recommendations on sulfonylurea and sulfonylurea combinations in the management of Type 2 diabetes mellitus – International Task Force

Abstract

For decades, sulfonylureas (SUs) have been important drugs in the antidiabetic therapeutic armamentarium. They have been used as monotherapy as well as combination therapy. Focus on newer drugs and concerns about the risk of severe hypoglycemia and weight gain with some SUs have led to discussion on their safety and utility. It has to be borne in mind that the adverse events associated with SUs should not be ascribed to the whole class, as many modern SUs, such as glimepiride and gliclazide modified release, are associated with better safety profiles. Furthermore, individualization of treatment, using SUs in combination with other drugs, backed with careful monitoring and patient education, ensures maximum benefits with minimal side effects. The current guidelines, developed by experts from Africa, Asia, and the Middle East, promote the safe and smart use of SUs in combination with other glucose-lowering drugs.

Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future

“…This is a first for the South African public healthcare system, providing local, realtime data that informs decision-making and guideline (Continued) 2014). However, this applies more to glibenclamide than other SUs including glipizide, glimepiride, and gliclazide as well as gliclazide modified release (MR) (Abrahamson, 2015;Colagiuri et al, 2018;Kalra et al, 2018). This is reflected in the current South African guidelines recommending that glibenclamide should no longer be prescribed, with for instance gliclazide MR replacing the more general term SUs (Naidoo et al, 2014).…”

Effect of Gliclazide or Gliclazide plus Metformin Combination on Glycemic Control in Patients with T2DM in India: A Real-World, Retrospective, Longitudinal, Observational Study from Electronic Medical Records

“…Sulfonylureas are a potent class of OADs and have been an important part of the antidiabetic therapeutic armamentarium for decades [ 27 ]. Glimepiride and gliclazide are one of the most commonly prescribed sulfonylureas in India [ 17 – 19 ].…”

“…The common adverse effects of gliclazide or gliclazide + metformin combination include hypoglycemia, neuropathy, fatigue, headache, abdominal pain, bronchitis, and vision disorders [ 21 – 23 , 28 – 31 ]. Gliclazide has also been recommended as an effective and tolerable first- or second-line agent (based on patient status) for the management of T2DM [ 27 ]. Despite the benefits of gliclazide usage, real-world evidence on the effectiveness of gliclazide in India was unavailable.…”

Safety of lixisenatide versus sulfonylurea added to basal insulin treatment in people with type 2 diabetes mellitus who elect to fast during Ramadan (LixiRam): An international, randomized, open-label trial

“…The absence of hypoglycemia during fasting hours while on lixisenatide + BI would certainly be welcomed by many Muslim patients who fast during Ramadan. The low number of hypoglycemia events with SU + BI was likely due to a combination of factors including most participants taking a modern SU, which have less hypoglycemia risk compared to the first-generation options [22]; 4.3% of participants used glibenclamide at baseline, which has been shown to have higher rates of hypoglycemia in other Ramadan studies [4,23,24]. However, 0% (0/3) of participants on glibenclamide during Ramadan fasting experienced 'any hypoglycemia' events during the fast.…”