Type 2 diabetes mellitus, a disorder of impaired insulin secretion and insulin resistance, has reached epidemic proportions. The identification of high-risk individuals and lifestyle management can help control diabetes; however, most patients require pharmacologic intervention.
To achieve glycemic control, a stepwise treatment approach has generally been used, beginning with a program of diet and exercise, and to minimize the risk of future micro- and macrovascular complications.
Oral agents, with or without insulin, are added when diet and exercise fail to normalize glucose levels. Various pharmacologic agents are available for the management of Type 2 diabetes, including first- and second-generation sulfonylureas (glimepiride, glipizide, and glyburide), biguanides (metformin), á-glucosidase inhibitors (acarbose and miglitol), thiazolidinediones (pioglitazone and rosiglitazone), meglitinide analogues (repaglinide), amino acid D-phenylalanine derivatives (nateglinide), and insulin.
A recent article, presented in vol 18 (6) of
Journal of Diabetes and its Complications reviews the role of the sulfonylureas - with a major focus on glimepiride, the newest of the second-generation sulfonylureas - in the medical management of Type 2 diabetes.
The sulfonylureas, the first oral agents introduced for the management of Type 2 diabetes, are effective, well-tolerated, and well-established drugs; Second-generation sulfonylureas are now widely used in the management of Type 2 diabetes. The most recent addition, glimepiride, can be used in combination with metformin, the thiazolidinediones, a-glucosidase inhibitors, and insulin. The unique properties of glimepiride may provide advantages over other currently available insulin secretagogues.
Type 2 diabetes mellitus can lead to serious long-term sequelae, such as blindness, kidney failure, heart disease, neurologic impairment, and stroke. Stringent lifestyle modifications, including diet and exercise, are important measures in diabetes management, but they are often not sufficient to control hepatic glucose output and hyperglycemia.
