Abstract
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.
Keywords
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Article info
Publication history
Published online: August 31, 2019
Accepted:
August 22,
2019
Received:
August 21,
2019
Identification
Copyright
© 2019 Published by Elsevier B.V.
