Glucodynamics and glucocracy in type 2 diabetes mellitus: clinical evidence and practice-based opinion on modern sulfonylurea use, from an International Expert Group (South Asia, Middle East & Africa) via modified Delphi method

Abstract

Type 2 diabetes mellitus (T2DM) is a global epidemic. According to international guidelines, the management protocol of T2DM includes lowering of blood glucose, along with preventing disease-related complications and maintaining optimal quality of life. Further, the guidelines recommend the use of a patient-centric approaches for the management of T2DM; however, Asian population is underrepresented in landmark cardiovascular outcome trials (CVOTs). There are several guidelines available today for the diagnosis and management of T2DM, and hence there is much confusion among practitioners about which guidelines to follow. A group of thirty international clinical experts comprising of endocrinologists, diabetologists and cardiologist from South Asia, Middle East and Africa met at New Delhi, India on February 8 and 9, 2020 and developed an international expert opinion statements via a structured modified Delphi method on the glucodynamic properties of OADs and the glucocratic treatment approach for the management of T2DM. In this modified Delphi consensus report, we document the glucodynamic properties of Modern SUs in terms of glucoconfidence, glucosafety, and gluconomics. According to glucodynamics theory, an ideal antidiabetic drug should be efficacious, safe, and affordable. Modern SUs as a class of OADs that have demonstrated optimal glucodynamics in terms of glucoconfidence, glucosafety, and gluconomics. Hence, modern SUs are most suitable second line drug after metformin for developing countries. Based on the current evidence, we recommend a glucocratic approach for the treatment of T2DM, where an individualized treatment plan with phenotype, lifestyle, environmental, social, and cultural factors should be considered for persons with T2DM in the South Asian, Middle Eastern and African regions.

Keywords:

• Sulfonylureas
• T2DM
• Delphi consensus
• glycemic control
• cardiovascular safety
• CAROLINA trial
• glimepiride

Transparency

Declaration of funding

This expert opinion initiative has been supported by Sanofi India. Medical writing and open access-related charges were paid for by Sanofi India.

The content published herein solely represents the views and opinions of the authors and does not necessarily represent the views or opinion of Sanofi and/or its affiliates. The details published herein are intended for informational, educational, academic and/or research purposes and are not intended to substitute for professional medical advice, diagnosis or treatment.

Declaration of financial/other relationships

The authors received no honoraria from Sanofi directly or indirectly related to the development of this publication. The experts received honoraria from Sanofi for participating in the two-day advisory board meeting. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author Contributions

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, had full access to the articles reviewed in this manuscript, have read and reviewed the final draft of this manuscript, take complete responsibility for the integrity and accuracy of this manuscript, and have given their approval for this version to be published.

Acknowledgements

Open Access funding provided by the Qatar National Library. We would like to thank Dr Rajshri Mallabadi and Dr Dhanya Mukundan from BioQuest Solutions Pvt. Ltd, Bangalore, for providing medical writing assistance and editorial support in the preparation of this manuscript, which was paid for by Sanofi, India.

Compliance with ethical guidance

This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Funding

This expert opinion initiative has been supported by Sanofi India. Medical writing and open access-related charges were paid for by Sanofi India. The authors received no honoraria from Sanofi directly or indirectly related to the development of this publication.