The Indication For Sulfonylurea Treatment

Treatment goals for diabetes demand near-normal glucose levels if possible in view of patient compliance and ability to follow therapeutic recommendations. This should be achieved with diet and exercise whenever possible. In the early phase of type 2 diabetes, insulin secretion typically is elevated (8), compared with healthy subjects, in an attempt to compensate for insulin resistance. Nevertheless, the chronically elevated levels of glucose, as occurs in manifest type 2 diabetes, indicate relative deficiency of insulin.

Insulinotropic agents are considered first-choice treatment in insulin-deficient patients who are not overweight, i.e., have a body mass index (BMI) < 25kg/m2 (9). In overweight patients, metformin and alpha glucosidase inhibitors are recommended first-choice treatment and insulinotropic agents can be added where blood glucose control is insufficient. In obese patients with type 2 diabetes, sulfonylureas are considered second-choice treatments since an increase in body weight of 2 to 4 kg was observed in most studies with either sulfonylureas or with insulin, but not with metformin. In obese patients, the use of sulfonylureas is indicated if hyperglycemia is not controlled by other agents, and many diabetologists will add a sulfonylurea to metformin.

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