Are Sulfonylureas Less Desirable Than DPP-4 Inhibitors As Add-on to Metformin in the Treatment of Type 2 Diabetes?

Overview

Journal Curr Diab Rep

Publisher Current Science

Specialty Endocrinology

Date 2011 Jan 19

PMID 21243448

Citations 8

Authors

Bo Ahren

Affiliations

Soon will be listed here.

Abstract

Sulfonylureas (SUs) are commonly used as add-on to metformin in treatment of type 2 diabetes in patients who are insufficiently controlled by metformin alone. They have good efficacy and have been shown to prevent microvascular complications. However, treatment with SUs is also associated with a high frequency of hypoglycemia, increased body weight, and a high risk of secondary failure. During recent years, dipeptidyl peptidase-4 (DPP-4) inhibitors have emerged as alternatives to SUs. They show similar efficacy as SUs but with lower risk of hypoglycemia, and reduction or no change in body weight, and if confirmed in humans, they may preserve islet function and thereby minimize the risk for secondary failure. Their limitation at present is the lack of long-term (>5 years) experience on durability and safety. Overall, therefore, the conclusion emerges that SUs are less desirable than DPP-4 inhibitors in management of hyperglycemia in type 2 diabetes.

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References

Harrower A . Comparison of efficacy, secondary failure rate, and complications of sulfonylureas. J Diabetes Complications. 1994; 8(4):201-3. DOI: 10.1016/1056-8727(94)90044-2. View

Levine R . Sulfonylureas: background and development of the field. Diabetes Care. 1984; 7 Suppl 1:3-7. View

. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131):837-53. View

Mu J, Woods J, Zhou Y, Roy R, Li Z, Zycband E . Chronic inhibition of dipeptidyl peptidase-4 with a sitagliptin analog preserves pancreatic beta-cell mass and function in a rodent model of type 2 diabetes. Diabetes. 2006; 55(6):1695-704. DOI: 10.2337/db05-1602. View

Dunning B, Foley J, Ahren B . Alpha cell function in health and disease: influence of glucagon-like peptide-1. Diabetologia. 2005; 48(9):1700-13. DOI: 10.1007/s00125-005-1878-0. View

Dhillon S . Sitagliptin: a review of its use in the management of type 2 diabetes mellitus. Drugs. 2010; 70(4):489-512. DOI: 10.2165/11203790-000000000-00000. View

Deacon C, Holst J . Linagliptin, a xanthine-based dipeptidyl peptidase-4 inhibitor with an unusual profile for the treatment of type 2 diabetes. Expert Opin Investig Drugs. 2009; 19(1):133-40. DOI: 10.1517/13543780903463862. View

Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M . Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008; 358(24):2560-72. DOI: 10.1056/NEJMoa0802987. View

Ahren B, Simonsson E, Larsson H, Landin-Olsson M, Torgeirsson H, Jansson P . Inhibition of dipeptidyl peptidase IV improves metabolic control over a 4-week study period in type 2 diabetes. Diabetes Care. 2002; 25(5):869-75. DOI: 10.2337/diacare.25.5.869. View

10.

Rendell M . The role of sulphonylureas in the management of type 2 diabetes mellitus. Drugs. 2004; 64(12):1339-58. DOI: 10.2165/00003495-200464120-00006. View

11.

Filozof C, Gautier J . A comparison of efficacy and safety of vildagliptin and gliclazide in combination with metformin in patients with Type 2 diabetes inadequately controlled with metformin alone: a 52-week, randomized study. Diabet Med. 2010; 27(3):318-26. DOI: 10.1111/j.1464-5491.2010.02938.x. View

12.

Perfetti R, Hui H . The role of GLP-1 in the life and death of pancreatic beta cells. Horm Metab Res. 2005; 36(11-12):804-10. DOI: 10.1055/s-2004-826167. View

13.

Adler A, Shaw E, Stokes T, Ruiz F . Newer agents for blood glucose control in type 2 diabetes: summary of NICE guidance. BMJ. 2009; 338:b1668. DOI: 10.1136/bmj.b1668. View

14.

Nathan D, Buse J, Davidson M, Ferrannini E, Holman R, Sherwin R . Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2008; 52(1):17-30. DOI: 10.1007/s00125-008-1157-y. View

15.

Arechavaleta R, Seck T, Chen Y, Krobot K, ONeill E, Duran L . Efficacy and safety of treatment with sitagliptin or glimepiride in patients with type 2 diabetes inadequately controlled on metformin monotherapy: a randomized, double-blind, non-inferiority trial. Diabetes Obes Metab. 2011; 13(2):160-8. DOI: 10.1111/j.1463-1326.2010.01334.x. View

16.

Mannucci E, Monami M, Lamanna C, Gori F, Marchionni N . Prevention of cardiovascular disease through glycemic control in type 2 diabetes: a meta-analysis of randomized clinical trials. Nutr Metab Cardiovasc Dis. 2009; 19(9):604-12. DOI: 10.1016/j.numecd.2009.03.021. View

17.

Campbell I . Comparing the actions of older and newer therapies on body weight: to what extent should these effects guide the selection of antidiabetic therapy?. Int J Clin Pract. 2010; 64(6):791-801. DOI: 10.1111/j.1742-1241.2009.02292.x. View

18.

Nordin C . The case for hypoglycaemia as a proarrhythmic event: basic and clinical evidence. Diabetologia. 2010; 53(8):1552-61. DOI: 10.1007/s00125-010-1752-6. View

19.

Rizzo M, Rizvi A, Spinas G, Rini G, Berneis K . Glucose lowering and anti-atherogenic effects of incretin-based therapies: GLP-1 analogues and DPP-4-inhibitors. Expert Opin Investig Drugs. 2009; 18(10):1495-503. DOI: 10.1517/14728220903241633. View

20.

Matthews D, Dejager S, Ahren B, Fonseca V, Ferrannini E, Couturier A . Vildagliptin add-on to metformin produces similar efficacy and reduced hypoglycaemic risk compared with glimepiride, with no weight gain: results from a 2-year study. Diabetes Obes Metab. 2010; 12(9):780-9. DOI: 10.1111/j.1463-1326.2010.01233.x. View