There is no evidence that sulfonylurea treatment causes beta-cell exhaustion; instead, the antihyperglycemic effect helps improve beta-cell function. Sulfonylurea "failures" are often dietary failures or may be due to late introduction of these drugs, i.e., when beta-cell function is already attenuated.
Full Answer
Are sulfonylureas safe?
Abstract. However, sulfonylureas, especially the older ones, are linked to a greater prevalence of hypoglycemia, and cardiovascular risk; newer prolonged-release preparations of sulfonylureas are undoubtedly safer, mainly due to reducing hypoglycemia, and for this reason should be preferred.
Why are sulfonylureas still used to treat diabetes?
Despite the great number of anti-diabetic agents currently available in clinical practice, sulfonylureas are still frequently used: maybe this is due to their lower cost, to the possibility of mono-dosing and to the presence of an association with metformin in the same tablet.
Do sulfonylureas increase the risk of heart failure?
Users of second-generation sulfonylureas had up to a 30% higher risk for congestive heart failure. Patients treated with Actos or Avandia did not appear to have a greater risk for heart attacks than those treated with metformin.
What is the mechanism of sulfonylurea?
Mechanism of action The main effect of sulfonylureas is the rise in plasma insulin concentrations; consequently they are effective only when residual pancreatic β-cells are present. The rise in plasma insulin levels occurs for two reasons.
Why do sulfonylureas stop working?
The impairment of the effect on insulin secretion that occurs during chronic administration of sulfonylureas is due to the down-regulation of the receptor for sulfonylureas on the surface of β-cells. This phenomenon disappears after discontinuing treatment for a period of time.
Do sulfonylureas lose effectiveness over time?
This additional insulin helps to lower blood sugar levels. Sulfonylureas can be combined with other types of diabetes medicines. Sulfonylureas work well at first but can lose their effectiveness over time.
What is sulfonylurea failure?
Primary sulfonylurea (SU) failure was defined as a <10% reduction in fasting plasma glucose (FPG) at the end of Week 4 from randomization. Secondary SU failure was defined as FPG ≥7.0 mmol/L on two consecutive tests 4 weeks after reaching the preset maximum or maximal tolerated SU doses.
Are sulfonylureas effective?
90% of patients successfully transfer from insulin to oral sulfonylureas with excellent initial glycaemic control; however, whether this control is maintained in the long term is unclear. Sulfonylurea failure is seen in about 44% of people with type 2 diabetes after 5 years of treatment.
How long do sulfonylureas take to work?
Table 1Class of hypoglycemic agentsDuration of actionDosageSulfonylureas12–24 hoursGlyburideUp to 24 hours1.25–20 mg as single dose or in two divided dosesGlipizide6–12 hours2.5–20 mg twice a dayGliclazide12 hours40–80 mg single dose 160–32010 more rows•Aug 15, 2012
What caution is there to a patient taking a sulfonylurea one answer?
Sulfonylurea Precautions Sulfonylureas shouldn't be taken by people with type 1 diabetes or diabetic ketoacidosis (a dangerous condition that can occur if high blood sugar is left untreated). People with liver or kidney problems may not be able to take sulfonylureas. Talk to your doctor if this is a concern.
Why sulfonylureas are not useful in type 1 diabetes?
Their action is dependent upon the presence of functioning Beta cells, therefore, sulfonylureas do not work in people with type 1 diabetes. Sulfonylureas stimulate insulin release by blocking ATP sensitive potassium channels in the Beta cells, reducing potassium permeability.
Is sulfonylurea better than metformin?
Conclusion. Sulfonylurea monotherapy is associated with higher risk for all-cause mortality, major hypoglycemic episodes, and cardiovascular events compared with metformin. Although the presence of CKD attenuated the mortality benefit, metformin may be a safer alternative to sulfonylureas in patients with CKD.
Why do sulfonylureas cause hypoglycemia?
Sulfonylureas also promote exocytosis of insulin through distinct mechanisms involving direct binding of pancreatic beta cell receptors. In summary, sulfonylurea medications promote hypoglycemia by increasing the release of endogenous insulin [5-7].
Is sulfonylurea better than metformin?
Conclusion. Sulfonylurea monotherapy is associated with higher risk for all-cause mortality, major hypoglycemic episodes, and cardiovascular events compared with metformin. Although the presence of CKD attenuated the mortality benefit, metformin may be a safer alternative to sulfonylureas in patients with CKD.
Why are second generation sulfonylureas preferred over first generation sulfonylureas?
The second generation sulfonylureas have largely replaced the first generation agents in routine use, because they are more potent, can be administered in lower doses, and can be given on a once daily basis.
Does sulfonylurea cause erectile dysfunction?
Does Sulfonylurea cause Erectile Dysfunction? No, on the contrary, Sulfonylureas can elevate Testosterone levels and thus increase libido and erectile function in men. On the other hand, Metformin is associated with a lowered sex drive and Erectile Dysfunction.
Why sulfonylureas are not useful in type 1 diabetes?
Their action is dependent upon the presence of functioning Beta cells, therefore, sulfonylureas do not work in people with type 1 diabetes. Sulfonylureas stimulate insulin release by blocking ATP sensitive potassium channels in the Beta cells, reducing potassium permeability.
Introduction
It is well established that type 2 diabetes is associated with an increased risk of cardiovascular morbidity and mortality ( 1 ). Although much of this association can be attributed to the long-term complications of this disease, there has been growing interest in determining whether certain antidiabetic drugs influence this risk.
Research Design and Methods
A MEDLINE search was conducted to identify all observational studies assessing the effects of sulfonylureas on the incidence of cardiovascular and cerebrovascular events, cardiovascular mortality, and all-cause mortality.
Conclusions
Assessing the cardiovascular safety of second- to third-line antidiabetic drugs can be challenging. As discussed above, certain design and analytical decisions can help circumvent some of these challenges and the biases that ensue.
Article Information
Funding. This research was funded in part by grants from the Canadian Institutes of Health Research and the Canadian Foundation for Innovation. L.A. is the recipient of a Chercheur-Boursier award from the Fonds de recherche du Québec - Santé. S.S. is the recipient of the James McGill Professorship award.
Is metformin the first line of treatment for type 2 diabetes?
Study researcher Ionna Tzoulaki, PhD, of the Imperial College London, tells WebMD the findings are consistent with current recommendations by the American Diabetes Association (ADA) and other diabetes groups designating metformin as the first-line oral treatment for type 2 diabetes.
Can you take metformin with sulfonylurea?
Bergenstal says that a sulfonylurea may still be a good option for individual patients who can't take metformin or need additional medication. Patients and their doctors have to weigh individual risks and benefits. No one should stop taking their medications based on this study, Tzoulaki tells WebMD.
