Sulfonylureas (SUs) are one of the commonly prescribed oral anti-hyperglycemic agents (AHA) in low- and middle-income countries (LMICs), either in combination with metformin therapy or alone. However, concern about cardiovascular safety has limited the use of SUs in the management of type 2 diabetes mellitus (T2DM). Additionally, lack of uniformity in the national and international guidelines regarding the positioning of SUs in the management of diabetes has also been reported. The objective of this review was to assess the various national and international guidelines on diabetes management and understand the recommendations specific to SUs in various scenarios. A total of 33 national and international guidelines on the management of T2DM published in English were evaluated. These guidelines have considered the latest evidence and suggest the use of certain second-generation SUs as second-line therapy or in combination with other AHAs in select population and specific scenarios. Identification of the appropriate population, classification based on underlying risk, thorough assessment of the comorbid conditions, and a step-wise approach for the selection of appropriate SUs is essential for the effective management of T2DM. Additionally, cost-to–benefit ratio should be considered, particularly in LMICs, and SUs could continue to play an important role in such settings.

Conclusion

Sulfonylureas continue to play a vital role in the management of T2DM. Majority of the international and national guidelines reviewed in this article suggest newer SUs as second-line therapy for treatment of people with T2DM. The newer SUs, such as glimepiride and gliclazide MR, are efficacious, comparatively less expensive and are associated with low rates of hypoglycemia, weight gain, and cardiovascular toxicity compared to the conventional SUs. Hence, despite the continuous advent of newer glucose-lowering therapies, SUs may still be an ideal pharmacological treatment choice in developing countries.

source: Pubmed