TITLE:
Sulfonylurea Glimepiride: A Proven Cost Effective, Safe and Reliable War Horse in Combating Hyperglycemia in Type 2 Diabetes
AUTHORS:
Udaya M. Kabadi
KEYWORDS:
Type 2 Diabetes, Sulfonylureas (SU)
JOURNAL NAME:
Journal of Diabetes Mellitus,
Vol.5 No.4,
October
16,
2015
ABSTRACT: Recently, a debate has been raised regarding the place and the role of sulfonylureas
(SU) amongst the armamentarium of drugs available for treatment of
hyperglycemia in subjects with type 2 diabetes mellitus. With the advent of new
drugs, SUs are being relegated and denigrated by some authorities contrary to
present recommendations by various organizations e.g. American Diabetes
Association, European Association for the Study of Diabetes and International
Diabetes Federation. In this article, the advantages of SUs over the new agents
in terms of their well established and proven better efficacy as well as their
short term and long term (over 50 years) safety based on extensive literature data are documented. Moreover,
lower costs of SUs render them to be far more cost effective when
compared to new agents and therefore make them affordable in many regions of
the world. Additionally, SUs are probably the initial drugs of choice in lean
subjects with prediabetes and type 2 diabetes because they are the most
effective secretogogues and major pathophysiologic mechanism of altered glucose
metabolism in lean subjects is the decline in insulin secretion and not rising
insulin resistance. Furthermore, SUs are also the most cost effective 2nd line agents in obese subjects with type 2 diabetes
on lapse of glycemic control while receiving metformin. Finally, with
progression of the disorder, the most cost effective combination of 2 oral
agents in conjunction with basal insulin remains to be metformin and SUs. Many
studies have documented a significantly greater extra pancreatic effect of glimepiride
in comparison to other SUs probably because of its unique property in enhancing
insulin sensitivity in conjunction with its ability to stimulate both 1st and
2nd phase insulin secretion. These characteristics may contribute to its
greater efficacy with lesser hypoglycemia when compared with other SUs. Lack of
hypoglycemic effect of metabolites of
glimepiride may also be responsible for lesser hypoglycaemia. Moreover,
metabolism of glimepiride performed partially by the liver and partially by the
kidneys may render it suitable and adaptable to be administered safely in
subjects with hepatic or renal dysfunctional as well as elderly. Finally, the
documentation of its pleiotropic effects in lowering of cardiovascular
surrogate markers, improving thrombotic milleau by reducing platelet
aggregation factors along with improvement in glycemic control and its
preferential binding to SU receptors on the pancreatic beta cells rather than
myocardium may be responsible for providing better cardiovascular outcomes in
comparison to other SUS and thus make it a better choice amongst SUs in
subjects with or without presence of cardiovascular disease. Additionally, once
daily administration because of lasting efficacy for 24 hours based on its half
life is likely to enhance compliance on the part of patients and assist in
attaining and maintaining desirable glycemic control. Therefore, SUs still
deserve to be major players in management of hyperglycemia in subjects with
type 2 diabetes mellitus and glimepiride may
be the best choice amongst SUs because of its long term record regarding
efficacy and safety in diverge population of subjects with type 2 diabetes
mellitus.