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Journal of Diabetology | Volume 3
Page 24
July 25-26, 2019 | Amsterdam, Netherlands
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DIABETES, NUTRITION,
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SULPHONYLUREAS: DO THEY STILL HAVE A PLACE IN THE MANAGEMENT OF TYPE 2
DIABETES?
Debashis Das
USV Private Limited, India
F
or years, sulphonylureas (SUs) have been the imperative drugs for the management of type 2 diabetes mel-
litus (T2DM), both as monotherapy and combination therapy. SUs are very efficacious class of drugs with
concerns of hypoglycaemia and weight gain. Also the concept of β-cell preservation did not go well with this
class of drugs. With these limitations the search went on to find the newer group of drugs such as sodium-glu-
cose co-transporter 2 (SGLT-2) and Glucagon-like peptide 1 (GLP-1) receptor agonists. In 2008, Food & Drug
Administration (FDA) issued guidance on the evaluation of cardiovascular risk in new anti-diabetic therapies
leading to cardiovascular outcomes trial (CVOT) which changed the way the anti-diabetic drugs were evalu-
ated and preferred. GLP-1 analogues such as Liraglutide and Semaglutide, SGLT-2 inhibitors like Empagliflozin
and Canagliflozin have shown to be not only CV safe and but CV protective in these trials. More than 80% of
the people globally with T2DM belong to developing countries where access and affordability are a major chal-
lenge, using these newer agents may not be practically feasible. Now the debate is whether SUs should be used
as the second line agent in the management of T2DM after metformin with lack of evidence of CV safety, risk of
hypoglycaemia and weight gain. There might not be a straight answer to this now but SUs would still continue
to be an important drug in the treatment of T2DM with the exponential rise in healthcare costs worldwide.
J Diabetol 2019, Volume 3