The Position of Gliclazide in the Evolving Landscapes and Disease Continuum of T2DM: A Collaborative Delphi Survey-Based Consensus from India

Abstract

Introduction This Delphi study aims to provide evidence-based expert opinion on the usage and current position of gliclazide in type 2 diabetes mellitus (T2DM) management in India. Methods The single interaction modified Delphi-based methodology was used to collect opinions on gliclazide usage and its position in diabetes management from 338 endocrinologists/diabetologists who have had clinical experience with gliclazide. Participants, using a 9-point scale, were asked to rate eight statements comprising a total of 52 items on the related topics. Results The Delphi consensus suggests that in drug-naïve patients with T2DM, intolerant to metformin or in whom metformin is contraindicated, dual therapy of gliclazide/gliclazide-modified release (MR) should be considered along with a dipeptidyl peptidase 4 (DPP4) inhibitor if glycated hemoglobin A1c level is greater than 7.5% and with insulin if the A1c level is greater than 9%. If the patients are inadequately controlled with metformin (A1c greater than 6.5% after 3 months of therapy), gliclazide/gliclazide-MR shall be added on to the treatment regimen to achieve greater and sustained reductions in A1c levels. However, it was not preferred over other antidiabetic classes in such clinical settings except alpha-glucosidase inhibitors (AGI). Early addition of gliclazide/gliclazide-MR shall be preferred over the up-titration of metformin beyond half-maximal dose for effective management of T2DM. Gliclazide/gliclazide-MR can be used safely in patients with diabetes and cardiovascular and chronic kidney disease. It can be used in older patients with T2DM as it does not have active metabolites and has a low risk of hypoglycemia. Conclusion The expert panel proposed consideration of monotherapy or dual therapy of gliclazide as an ideal choice in patients with T2DM because of its efficacy, long-term glycemic control, favorable renal outcomes, cardiovascular safety, and an optimal safety profile. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-021-01002-4.

Pathophysiology, phenotypes and management of type 2 diabetes mellitus in Indian and Chinese populations

“…Although sulfonylureas can cause hypoglycaemia and weight gain 165 , they are cheap and are the second most common oral glucose-lowering medication in India [166][167][168] and China 169,170 after metformin. Glycaemic improvements with sulfonylureas might be less durable compared with improvements with other classes of glucose-lowering medication owing to accelerated β-cell failure, especially with older sulfonylureas 165 .…”

INFLUENCE OF Momordica charantia (L.) ON THE PHARMACOKINETICS AND PHARMACODYNAMICS OF GLICLAZIDE IN ALLOXAN-INDUCED DIABETIC RATS

“…Currently, insulin and oral antidiabetics are used to treat DM. Gliclazide is a secondgeneration sulfonylurea antidiabetic drug that is the first choice for the treatment of DM in patients intolerant to metformin (Khunti et al, 2020;Karla et al, 2021). DM is a chronic disease whose treatment requires a long time; therefore, many DM sufferers use alternative treatments in the form of herbs or as a complementary treatment to DM therapy (Ilhan et al, 2016;Joeliantina et al, 2016;Grossman, Roscoe and Shack, 2018).…”