Sulfonylurea, diabetes treatment

It is well known that diabetic patients undergoing coronary interventions have worse chnical and angiographic outcomes in comparison with nondiabetic patients. In the retrospective analysis of the PRESTO (Prevention of Restenosis with Tranilast and its Outcomes) trial the effect of different anti-diabetic treatment was analysed [40] in 1,110 diabetic patients who received non-sensitizer therapy (insulin and/or sulfonylureas) and in 887 patients who were treated with sensitizers (metformin with or without additional therapy). Compared with patients on non-sensitizer therapy, those on sensitizer therapy showed an adjusted OR of 0.72 p = 0.005 for any clinical event. The differences between the non-sensitizer therapy group and the sensitizer group were attributable mainly to decreased rates of death (OR = 0.39 p = 0.007) and myocardial infarction (OR = 0.31 p = 0.002). In this retrospective analysis, use of metformin in diabetics undergoing coronary interventions appeared to decrease adverse clinical events, especially death and myocardial infarction, compared with diabetic patients treated with non-sensitizer therapy. 

Keywords Type 2 diabetes, treatment, insulin. Metformin, sulfonylurea, glitazones, triple therapy, glycaemic control. 

In an open-label comparison of exenatide with insulin glargine in diabetic patients suboptimally controlled with metformin and sulfonylurea, both treatment regimens led to a reduction in HbA levels by -1.1% after 26 weeks (baseline 8.2%)... 

Meglitinide contains a benzamide group. Meglitinide-related compounds such as nateglinide are non-sulfonylurea oral hypoglycemic drugs used in the treatment of type 2 (non-insulin dependent) diabetes mellitus. 

Type 2 diabetes mellitus For type 2 diabetes, as an adjunct treatment in patients who use mealtime insulin therapy and who have failed to achieve desired glucose control despite optimal insulin therapy, with or without a concurrent sulfonylurea agent and/or metformin. 

Repaglinide en nateglinide are not sulfonylurea agents but their mechanism of action is very alike. Repaglinide is the first carbamoylmethyl-benzoic acid derivative that has been registred for the treatment of diabetes mellitus. It closes ATP-dependent potassium channels in the beta cell membrane with consequent depolarization, opening of calcium channels and increased insulin release. It is rapidly absorbed with peak plasma levels after 1 hour. It has a protein binding of over 98%. 

Krentz AJ, Boyle PJ, Justice KM, Wright AD, Schade DS. Successful treatment of severe refractory sulfonylurea-induced hypoglycemia with octreotide. Diabetes Care 1993 16(l) 184-6. 

Sulfonylureas are the most widely prescribed drugs in the treatment of type 11 diabetes mellitus. The initial sulfonylureas were introduced nearly 50 years ago and... 

Exenatide (synthetic exendin-4, from the saliva from a lizard), which has a 53% overlap with glucagon-like peptide-1 and which also binds to the glucagon-like peptide-1 receptor, has been investigated in a placebo-controlled study for 28 days in 116 patients with type 2 diabetes in addition to a sulfonylurea or metformin (1). The most common adverse effects were nausea (mostly only in the first week) and mild to moderate hypoglycemia, for which no treatment was needed. 

Fineman MS, Bicsak TA, Shen LZ, Taylor K, Gaines E, Varns A, Kim D, Baron AD. Effect of glycemic control of exenatide (synthetic exendine-4) additive to existing metformin and/or sulfonylurea treatment in patients with type 2 diabetes. Diabetes Care 2003 26 2370-7. 

In a period of 12 months 23 episodes of severe hypoglycemia were recorded in those taking a sulfonylurea in a district with a population of 367 051 (8655 with diabetes) (55). The total cost of emergency treatment was estimated to be up to 92 078/year. 

Old age increases sensitivity to sulfonylureas and the frail elderly are at greatest risk (142). Chlorpropamide is no longer recommended for treatment of type 2 diabetes. However, in 1993 and 1994, of 3050 older Mexican Americans, 365 used inappropriate medicines, of whom 36 used chlorpropamide (143). In a comparable study of 5734 patients over 65 years old, hospitalized in 81 geriatric... 

Exercise training can force a reduction in the dose of various drugs in the treatment of diabetes (149). The hypoglycemic action of exercise in combination with sulfonylurea on postabsorptive glucose concentration is mainly caused by greater inhibition of glucose production in the liver (150). 

Fibrates are highly bound to albumin and displace other similarly bound drugs. This can affect treatment with sulfonylureas. Hypoglycemia occurred in a diabetic patient taking glibenclamide plus gemfibrozil (170). 

Korytkowski MT. Sulfonylurea treatment of type 2 diabetes mellitus focus on glimepiride. Pharmacotherapy 2004 24 606-20. 

Zhu X-X, Pan C-Y, Li G-W, Shi H-L, Tian H, Yang W-Y, Jiang J, Sun X-C, Davies C, Chow W-H. Addition of rosiglitazone to existing sulfonylurea treatment in Chinese patients with type 2 diabetes and exposure to hepatitis B or C. Diabetes Technol Ther 2003 5 33-42. 

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