Place of sulfonylureas in the management of type 2 diabetes mellitus in South Asia: A consensus statement

Abstract

Since their introduction in clinical practice in the 1950's, Sulfonylureas (SUs) have remained the main-stay of pharmacotherapy in the management of type 2 diabetes. Despite their well-established benefits, their place in therapy is inappropriately being overshadowed by newer therapies. Many of the clinical issues associated with the use of SUs are agent-specific, and do not pertain to the class as such. Modern SUs (glimepiride, gliclazide MR) are backed by a large body of evidence, experience, and most importantly, outcome data, which supports their role in managing patients with diabetes. Person-centred care, i.e., careful choice of SU, appropriate dosage, timing of administration, and adequate patient counseling, will ensure that deserving patients are not deprived of the advantages of this well-established class of anti-diabetic agents. Considering their efficacy, safety, pleiotropic benefits, and low cost of therapy, SUs should be considered as recommended therapy for the treatment of diabetes in South Asia. This initiative by SAFES aims to encourage rational, safe and smart prescription of SUs, and includes appropriate medication counseling.

Glycemic control and cost-effectiveness attained by the drug utilization of oral antidiabetic agents in a tertiary care hospital in South India

“…15 Glimepiride has been advocated as the sulfonylurea of choice in obese diabetics and south Asians. 16 Reduction in rate of prescription of glibenclamide (n=16) can be due to its higher incidence of hypoglycaemia and cardiovascular mortality on long term use. 15,17 Voglibose, which was approved a decade ago, was prescribed for 41 patients and vildagliptin the newest and expensive agent was prescribed for 23 patients.…”

Comparative efficacy and safety of DPP-4 inhibitors and α-glucosidase inhibitors as add on therapy in type 2 diabetes

“…7 Among the sulfonylureas glimepiride is considered to have a greater potency and better safety profile and is the commonest to be prescribed with metformin. 8 Nevertheless, dual combination therapy with metformin and a sulfonylurea may not achieve or maintain adequate glycemic control. 6 This necessitates the addition of a third oral anti diabetic agent which is increasingly being used in clinical practice.…”

Evaluación de la prescripción de glibenclamida en diabéticos tipo 2

“…A pesar de ello las sulfonilureas se constituyen en un grupo de medicamentos ampliamente utilizados, aun con la introducción de medicamentos como los inhibidores de dipeptidil-peptidasa-IV y los análogos del péptido similar al glucagón tipo 1 2 . Estos continúan siendo los antidiabéticos más prescritos en algunas regiones del mundo 3 , permaneciendo junto con la metformina como el tratamiento farmacológico más usado 4 .…”