Abstract
This chapter summarises information for each of the non-insulin drug classes that are used for blood glucose control. Each summary is accompanied by a table of recommendations to guide the clinical use of these medications. For the sake of completeness, and for those that are interested, we have included a more detailed review of each drug as an appendix to each summary. These can be found in the Appendix section of the guidelines. The treatment recommendations for each drug have been incorporated into the treatment algorithm in Chapter 11. The following abbreviations are used in this chapter: DPP-4: dipeptidyl peptidase-4 GLP-1: glucagon-like peptide-1 SGLT2- sodium-glucose linked transporter-2
Highlights
This chapter summarises information for each of the non-insulin drug classes that are used for blood glucose control
Gliclazide modified-release is a sulphonylurea (SU) and insulin secretagogue that binds selectively to the sulphonylurea receptor-1A (SUR1A) binding-site of KATP channels on pancreatic beta cells resulting in membrane depolarization, calcium influx and exocytosis of stored insulin
Gliclazide modified-release increases the risk of hypoglycaemia when used as monotherapy or combination therapy, but this is significantly lower when compared to glibenclamide and glimepiride
Summary
Proven superiority vs. diet alone in obese patients - reduced all-cause mortality, diabetes related mortality and myocardial infarction, but not peripheral vascular disease or microvascular disease. Proven superiority vs SU and insulin in obese patients: reduced all cause mortality and stroke, but not myocardial infarction, diabetes-related deaths, peripheral vascular disease or microvascular disease. Safety when added to SU’s (glibenclamide and chlorpropamide) is unclear. Some patients may have symptoms of hypoglycaemia. Can potentiate the hypoglycaemic effect of insulin or insulin secretagogues. Weight neutral or causes modest weight loss (-1.2kg). May improve outcomes in mild to moderate heart failure; Improves laboratory measures of inflammation, coagulation, oxidative stress, endothelial function and tumour suppression; cancer rates are lower. Www.tandfonline.com/oemd 4 The page number in the footer is not for bibliographic referencing
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