Hypoglycemia is the major safety concern with sulfonylureas. Large studies have provided numbers for hypoglycemic episodes associated with some of the sulfonylureas used. The longer the duration of action and the more potent a compound, the higher the risk of hypoglycemia. Typically, elderly nonobese patients with type 2 diabetes who are given long-acting sulfonylureas and may miss a meal after having received the treatment are at highest risk. The presence of renal and/or hepatic insufficiency enhances the risk, due to impaired gluconeogenesis. In renal insufficiency, accumulation of compounds may occur due to decreased elimination.

There are few detailed studies about the use of sulfonylureas in renal impairment. Moderate reductions in creatinine clearance (up to 60 mL/min) require dose reductions, but allow the use of most sulfonylureas, whereas more severely compromised kidney function represents a contraindication. Gliquidone is almost completely eliminated in the feces after hepatic metabolism to inactive metabolites, and < 5% are eliminated via the kidney. This is therefore the safest agent to use for type 2 diabetes treatment in renal insufficiency (26,27).

The shorter acting meglitinides may possess a lower risk of hypoglycemia simply because of the short duration of action and intake with meals, although not all studies have confirmed this assumption (16,28). Observational studies have suggested that glimepiride is less frequently associated with severe hypoglycemia than glibenclamide, but this was not shown in prospective controlled trials.

Delicious Diabetic Recipes

Delicious Diabetic Recipes

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