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The right place for Sulphonylureas today: Part of review the series: Implications of recent CVOTs in Type 2 Diabetes Mellitus.

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journal contribution
posted on 23.09.2019, 10:59 by David R. Webb, Melanie J. Davies, Janet Jarvis, Sam Seidu, Kamlesh Khunti
The place of Sulphonylurea based insulin secretagogues in the management of Type 2 diabetes appears as controversial today as it was fifty years ago. Newer therapies are associated with less hypoglycaemia and weight gain than Sulphonylureas but currently cost more and lack assurances which come with long-term exposure. Emergence of recent CVOT data for SGLT-2 inhibitors and GLP-1 receptor agonists is likely to influence therapeutic choices and guidance is now supportive of their earlier use in cases at high risk of cardiovascular disease. Meta-analyses of Sulphonylurea trials have failed to indicate a consistent effect (positive or negative) on cardiovascular disease or mortality, although are limited by the relative scarcity of studies directly reporting these outcomes. The CAROLINA trial is reassuring in demonstrating cardiovascular safety for the Sulphonylurea Glimepiride when compared directly with the DPP-4 inhibitor Linagliptin, suggesting either of these agents would be relatively safe second line options after Metformin in the majority of patients. This review provides a balanced assessment of available Sulphonylurea treatments in the context of current cardiovascular outcome trial data (CVOT) data and hopefully assists informed decision making about the place of these drugs in contemporary glucose lowering practice.

History

Citation

Diabetes Research and Clinical Practice, 2019

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Diabetes Research Centre

Version

AM (Accepted Manuscript)

Published in

Diabetes Research and Clinical Practice

Publisher

Elsevier for International Diabetes Federation

eissn

1872-8227

Acceptance date

22/08/2019

Copyright date

2019

Publisher version

https://www.sciencedirect.com/science/article/pii/S0168822719311593?via=ihub

Notes

The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.

Language

en