The role of sulfonylureas in the treatment of type 2 diabetes

ABSTRACT

Introduction

Type 2 diabetes (T2D) is increasingly prevalent and associated with increased risk for cardiovascular and renal disease. After lifestyle modification, metformin is usually the first-line pharmacotherapy and sulfonylureas are traditionally added after metformin failure. However, with newer glucose lowering drugs that may have less risk of hypoglycemia or that may reduce cardiovascular and renal events, the position of sulfonylureas is being reevaluated.

Areas covered

In this article, the authors review relevant publications related to the use of sulfonylureas.

Expert opinion

Sulfonylureas are potent glucose lowering drugs. The risk of hypoglycemia varies with different drugs within the class and can be minimized by using the safer drugs, possibly in lower doses. Cardiovascular events do not appear to be increased with some of the newer generation drugs. The durability of glycemic control also appears comparable to other newer agents. Sulfonylureas are the preferred treatment for some types of monogenic diabetes and selection of T2D patients who may have greater benefit from sulfonylureas based on certain phenotypes and genotypes is likely to be refined further by precision medicine. Sulfonylureas are inexpensive and readily available everywhere and they are still the most frequently used second-line treatment for T2D in many parts of the world.

KEYWORDS:

• Cardiovascular events
• gliclazide
• glimepiride
• glipizide
• glycemic durability
• hypoglycemia
• sulfonylureas
• type 2 diabetes

Article highlights

• Sulfonylureas are established as the second-line oral glucose lowering medication for T2D after metformin and are still widely used worldwide.

• Newer hypoglycemic agents with less risk for hypoglycemia or with proven cardiovascular benefits are becoming more popular and are given priority to sulfonylureas in some guidelines.

• Sulfonylureas differ in their selectivity for pancreatic beta-cells and in their risk for cardiovascular events and hypoglycemia with the most favorable profile seen with gliclazide followed by glimepiride and glipizide

• Sulfonylureas are the treatment of choice in some forms of monogenic diabetes.

• Precision medicine should improve the selection of patients with T2D according to phenotypic or genetic factors to help to identify those who may benefit most from sulfonylurea treatment.

Declaration of Interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was funded by faculty research funding from the Faculty of Medicine, Macau University of Science and Technology.