Glucocrinology of Modern Sulfonylureas: Clinical Evidence and Practice-Based Opinion from an International Expert Group

Abstract

Aim: The primary objective of this document is to develop practice-based expert group opinion on certain important but less discussed endocrine and metabolic effects of modern sulfonylureas (SUs) and their usage in the management of diabetes mellitus (DM). Background: Modern SUs may be considered a panacea in DM care with their beneficial extrapancreatic, pleiotropic, and cardiovascular effects. Safe glycemic control with SUs could be achieved with appropriate patient selection, drug and dosage selection, and patient empowerment. Additionally, sulfonylureas also exhibit certain endocrine and metabolic effects, which could be considered beneficial in the management of DM. In this regard, a group of international clinical experts discussed the less known beneficial aspects of SUs and safe and smart prescription of modern SUs in DM care. Results: The concept of glucocrinology or the relationship of glycemia with the endocrine system was emphasized during the meetings. Clinical experts arrived at a consensus for the Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.8263688.

Glimepiride and Metformin Combinations in Diabetes Comorbidities and Complications: Real-World Evidence

“…The results of the present study indicate good glycemic control at all the age groups and showed a sustained legacy effect maintained for a longer duration of diabetes, which was in concordance with the study conducted by Kalra S et al [ 4 ]. Early combination therapy with the glimepiride and metformin combination could provide the benefit of a legacy effect through earlier glucose control, avoiding a negative glycemic memory related to micro- and macrovascular complications [ 6 ].…”

“…The combination of modern sulfonylurea (glimepiride) and metformin is widely prescribed for effective blood glucose control due to its capability of counteracting “insulin secretion disorder” and “insulin resistance,” respectively. In India, multiple strengths of the glimepiride and metformin fixed-dose combination are available and widely used by primary care physicians and specialists [ 4 ]. The current study is aimed to analyze the usage of various strengths of the glimepiride and metformin combination in the management of T2DM patients with comorbidities and complications.…”

Effects of Initial Combinations of Gemigliptin Plus Metformin Compared with Glimepiride Plus Metformin on Gut Microbiota and Glucose Regulation in Obese Patients with Type 2 Diabetes: The INTESTINE Study

“…Because of their good glucose-lowering efficacy, sulfonylureas have been widely used together with metformin for rapid glucose control in patients with type 2 diabetes [ 4 ]. However, the possibility of increased risk of hypoglycemia and likely weight gain associated with this therapy, combined with the availability of newer agents with fewer side effects and additional benefits of preventing cardiovascular events, has led to a reduction in the frequency of prescription of sulfonylureas [ 5 ].…”

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

“…Factors that are considered while prescribing an OAD include safety, efficacy, tolerability, and cost-effectiveness. 6 Sulfonylureas (SUs) are one of the oldest and most important class of OADs that are currently available for the management of T2DM. Modern SUs (glimepiride and gliclazide MR) are more effective and have a better safety profile as compared to conventional SUs (glibenclamide) and are also associated with additional pleiotropic benefits, such as anti-inflammatory and immunomodulatory effects, along with endocrine and metabolic effects.…”

“…Modern SUs (glimepiride and gliclazide MR) are more effective and have a better safety profile as compared to conventional SUs (glibenclamide) and are also associated with additional pleiotropic benefits, such as anti-inflammatory and immunomodulatory effects, along with endocrine and metabolic effects. 6 Recent international guidelines recommend, a glucose-lowering medication with proven cardiovascular and/or mortality-reducing benefit for patients with T2DM in whom lifestyle modification and metformin use have failed to achieve glycemic targets. 7 Guidelines should consider lifestyle, phenotype, social and cultural factors-along with patient preferences and comorbidities.…”