The Place of Sulfonylureas in the Evolving Landscape of Combination Therapy

Abstract

This article summarizes a presentation from a recent symposium entitled ''SUs in the treatment of T2DM: a fresh look and new insights'' held on 18 September 2019 during the 55th Annual Meeting of the European Association for the Study of Diabetes (EASD) in Barcelona, Spain, and discusses whether sulfonylureas (SUs) are a good 'team player.' It examines the likely impact of using SUs early in the course of type 2 diabetes mellitus (T2DM), either alone or in combination with other agents, on glycemic outcomes and net side effects. The management of patients with T2DM and cardiovascular disease or chronic kidney disease is discussed, highlighting how glycemic control and cardiorenal effects are equally important in these patients and chronic exposure to hyperglycemia should be minimized. The role of SU-based combination therapy in this patient group is explored, demonstrating how later-generation SUs, either as monotherapy or combined with other antidiabetic drugs, help to ensure maximum benefits with minimal side effects. Evidence regarding the combination of SUs with a sodium-glucose transport protein 2 inhibitor shows that this might prove to be a good clinical option, especially in patients with renal impairment.

Tackling type 2 diabetes-associated cardiovascular and renal comorbidities: a key challenge for drug development

“…Other studies showed that the blood level of SU increases in patients with CKD, thereby increasing the risk of developing hypoglycemia when compared with metformin [35]. In contrast, some reports indicate that SU has a strong ability to reduce HbA1c in DM patients [36]. The risk of the cardiovascular or renal event was almost the same in a large cohort of patients (>23,000) taking either SU + metformin or DPP4 inhibitor + metformin.…”

“…glibenclamide, glimepiride) have been a dependable hypoglycemic agent for more than 70 years, several reports have shown that this group of glucose-lowering agent can make cardiovascular events worse [33,34]. Other reports have suggested that SU should be used with care in patients with CKD because blood SU level increases in subjects suffering from CKD [35][36][37][38].…”