Evaluating gliclazide for the treatment of type 2 diabetes mellitus

ABSTRACT

Introduction

Sulfonylureas have been the standard second-line treatment after failure of metformin monotherapy in patients with type 2 diabetes (T2D) but they are becoming less popular as the newer glucose-lowering agents have a relatively lower risk of hypoglycemia and some of them have been shown to reduce cardiovascular and renal events. Gliclazide differs from other sulfonylureas in several respects and may provide a suitable option for some patients with T2D.

Areas covered

In this article, we review the pharmacokinetics, pharmacodynamics and clinical efficacy of gliclazide based on the available literature.

Expert opinion

Gliclazide in the modified release (MR) formulation given once daily provides a good 24-h glycemic efficacy comparable to most other groups of glucose lowering drugs. Hypoglycemic events are less frequent than with some other sulfonylureas, and weight gain is not a major problem. Cardiovascular outcome studies have shown no evidence of increased cardiovascular events with gliclazide, and the durability of glucose lowering effects is comparable to other drug groups. Lower doses of gliclazide appear to have an incretin-enhancing effect, and overall it can provide a cost-effective treatment that is useful in many patients.

KEYWORDS:

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

Article highlights

• Gliclazide is one of the sulfonylureas that is well established as a second-line oral glucose lowering medication for T2D after metformin and is widely used in many countries.

• The sulfonylureas differ in their selectivity for SUR receptors in pancreatic beta-cells compared to those in the cardiovascular system and this may be relevant to cardiovascular events.

• Compared to other sulfonylureas, gliclazide MR shows a favorable profile for glycemic efficacy and durability and the risk of hypoglycemia

• Low doses of gliclazide may provide an incretin effect, which may be a useful option for many patients.

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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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.