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SUs Revisited

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Dr Rajesh Marya, New Delhi    24 November 2018

  1. Data suggest that treatment with SUs leads to 0.5-2% HbA1c reduction compared to other therapies. Current literature does not support the notion that SUs are harmful to b-cell mass or function. On the contrary, SUs appear to improve β-cell secretory capacity when used early in the course of T2DM. Glimepiride seems to enhance b-cell secretion/mass.
  2. SUs are an effective, safe, well-tolerated, affordable and convenient therapeutic option in the management of T2DM. They are effective second-line agents after metformin in the management of T2DM. SU monotherapy as first-line may be considered in type 2 diabetes patients with metformin intolerance/contraindication and in patients with MODY.
  3. Modern SUs should be initiated early in the course of T2DM, to achieve maximum glycemic benefits and obtain the benefits of metabolic memory.
  4. SU-containing dual or triple FDCs, if available (with drugs that have complementary modes of action), reduce cost, offer convenience and improve patient adherence. SUs clearly have a place in the care of T2DM patients and should be considered an important part of the armamentarium. They have a robust evidence-base, have potent glycemic action, yield durable glycemic control, are weight-neutral, are associated with less risk of hypoglycemia, are cardio-safe and are cost-effective.
  5. Real-world evidence in patients newly diagnosed with type 2 diabetes – Despite the introduction of newer therapies, SUs remained the most popular second-line agent and the rates of intensification with SUs and insulin remained consistent over time.

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