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Sulfonylurea Combinations: An International Consensus

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Dr Sarita Bajaj, President    31 January 2018

  1. As compared to older SUs, glimepiride: Has lower risk of hypoglycemic events; exhibits a higher exchange rate and lower binding affinity to b cells.
  2. Potent efficacy confirmed with modern SU: Patients treated with glimepiride, have: 12% greater reduction in HbA1c; 4 mg/dl greater reduction in FPG; significantly fewer dropouts; 20% less risk of needing rescue treatments.
  3. A combination of metformin and SUs helps in addressing multiple etiologies of hyperglycemia. The use of 2nd and 3rd generation SUs in patients with type 2 diabetes is not associated with increased CV risk irrespective of comparator or background medication. SUs as an add-on to metformin have been considered safe in terms of overall and CV mortality. SUs have durable action and b-cell exhaustion with SU is a myth.
  4. SUs are not associated with increased risk for all-cause mortality, CV mortality, MI or stroke. SUs cause maximum reduction of HbA1c.
  5. Safe and Smart Plus: An International Task Force with experts from Africa, Asia and Middle East. This is a guidance on usage of SUs in combination with other OADs, as well as insulin, to help physicians across the country and beyond.

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