Sulfonylureas: Assets in the past, present and future

Frequency of CYP2C9 (*2, *3 and IVS8-109A>T) allelic variants, and their clinical implications, among Mexican patients with diabetes mellitus type 2 undergoing treatment with glibenclamide and metformin

The majority of Mexican patients with diabetes mellitus type 2 (DMT2) (67.9-85.0%) are prescribed sulphonylureas (SUs), which are metabolized by cytochrome P450 2C9 (abbreviated as CYP2C9). SUs are a type of oral anti-diabetic compound which inhibit ATP-sensitive potassium channels, thus inducing glucose-independent insulin release by the β-pancreatic cells. The wide variability reported in SU responses has been attributed to the polymorphisms of CYP2C9. The present study aimed to describe CYP2C9 polymorphisms (*2, *3 and IVS8-109T) within a sample of Mexican patients with DMT2, while suggesting the potential clinical implications in terms of glibenclamide response variability. From a sample of 248 patients with DMT2 who initially consented to be studied, those ultimately included in the study were treated with glibenclamide (n=11), glibenclamide combined with metformin (n=112) or metformin (n=76), and were subsequently genotyped using a reverse transcription-quantitative polymerase chain reaction (PCR), end-point allelic discrimination and PCR amplifying enzymatic restriction fragment long polymorphism. Clinical data were gathered through medical record revision. The frequencies revealed were as follows: CYP2C9*1/*1, 87.5%; *1/*2, 6.5%; *1/*3, 5.2%; and CYP2C9, IVS8-109A>T, 16.1%. Glibenclamide significantly reduced the level of pre-prandial glucose (P<0.01) and the percentage of glycated hemoglobin (%HbA1c; P<0.01) for IVS8-109A>T compared with combined glibenclamide and metformin treatment. Concerning the various treatments with respect to the different genotypes, the percentages obtained were as follows: Glibenclamide A/A, HbA1c<6.5=33.3%; glibenclamide + metformin A/A, HbA1c<6.5=24.6%; glibenclamide A/T, HbA1c<6.5=33.3%; glibenclamide + metformin A/T, HbA1c<6.5=25%; glibenclamide T/T, HbA1c<6.5=100%; and glibenclamide + metformin T/T, HbA1c<6.5=12.5%. Altogether, these results revealed that, although genetically customized prescriptions remain a desirable goal to increase the chances of therapeutic success, within the studied population neither allelic variants nor dosages demonstrated a clear association with biomarker levels. A key limitation of the present study was the lack of ability to quantify either the plasma concentrations of SU or their metabolites; therefore, further, precise experimental and observational studies are required.

Modern Sulfonylureas Strike Back - Exploring the Freedom of Flexibility

This editorial discusses the concept of flexibility in diabetes care. Flexibility of an oral antidiabetic drug (OAD) is defined as its ability to be used efficaciously and safely, in flexible, convenient doses and frequencies, at flexible timings of administration. This flexibility also includes OAD usage alone or in combination with a wide spectrum of drugs, in a wide spectrum of patients, irrespective of their age, gender, health status, or dietary patterns, with flexible dose titration, glucose monitoring and healthcare contact schedules. This editorial examines the flexibility of the modern sulfonylureas such as gliclazide extended (modified) release (MR) preparation in the management of diabetes. Using evidence-based rationale, we demonstrate that gliclazide MR is a flexible, and useful option for the management of type 2 diabetes.

Progressing From Metformin to Sulfonylureas or Meglitinides

The article provides an overview of sulfonylureas and meglitinides as second-line agents for treating type 2 diabetes mellitus (T2DM). Implications for occupational health clinicians who work with these individuals when they take either of these medications to achieve target glycemic indices are emphasized.

Effects of gliclazide add on metformin on serum omentin-1 levels in patients with type 2 diabetes mellitus

BACKGROUND

Omentin is a newly identified adipokine that has beneficial influence against cardiovascular disorders. Hence, considering the impact of anti-diabetic drug on omentin levels may provide an adjuvant strategy to protect diabetic patients against valuable clinical hazards.

AIM OF THE STUDY

To investigate the influence of metformin alone or in combination with gliclazide on the level of serum omentin among patients with type 2 diabetes mellitus (T2DM).

PATIENTS AND METHODS

A total of 70 newly diagnosed patients with T2DM were enrolled in this randomized, double-blind prospective study, and divided into two equal groups based on treatment regimen in which Group 1 treated with metformin (1000 mg) and Group 2 treated with metformin (1000 mg) plus gliclazide (80 mg). Blood glucose levels, HbA1C, insulin levels, and serum omentin-1 were measured at baseline and after 12 weeks of treatment.

RESULT

Use of gliclazide as an add-on therapy to metformin in patients with T2DM result in better glycemic control evidenced by significant reductions in the levels of blood glucose levels and HbA1C and much more improvement in insulin sensitivity evidenced by significant decreased in insulin resistance index, whereas it has adverse impact on serum omentin-1 levels evidenced by significant decrement in omentin-1 level in comparison to their pretreatment levels among Group 2 patients.

CONCLUSIONS

Adding of gliclazide to metformin in treatment of patients with T2DM might extend the therapeutic action of metformin in regarding much better controlling of glycemic indices, but, at the same time, it might attenuate the cardioprotective effects of metformin by its adverse influence on serum omentin-1 levels.