Wednesday, April 11, 2012

Sulfonylureas are still controversial

 Medscape published another review written by Mathew  L. Mintz, MD Matthew L. Mintz, MD 
.Sulfonylureas in Diabetes: Why So Controversial?

This is a topic worth continued attention. He reviews the recent guide lines of the American 
college of Physicians. This group recommended metformin as the first medication choice when diet and exercise fail and suggested a more individualized approach when metformin alone is not enough .
Medication  effectiveness is about the same with most of the other medications,however  the other issues such as safety, weight gain and preservation of Beta cell is different.

         Safety - hypoglycemia with sulfonylureas is  6 times more common  than with drugs 
                       such as pioglitazone ( ACTOS }. Hypoglycemia is also a problem with insulin.

        Weight gain - sulfonylureas , pioglitazone  ( edema ) , insulin

        Preserve Beta cell function - "Sulfonylureas seem to "burn out" the Beta cells and fail ".

                                                            pioglitazone  and probable DPP-4 inhibitors and GLP-1 
                                                            agonist preserve Beta cell function

        Least expensive -  sulfonylureas
        Known risk-          sulfonylureas
The last 2 items listed , known risk and cost , have a significant  effect on our choices of medications. The newer medication may have risk that have not yet surfaced. 

The glitazones , Actos ( piogliatzone) and Avandia ( rosiglitazone  ) have their issues with edema , questionable heart problems with Avandia  ,and bladder tumors in mice with piogliazone . These  problems have limited their use.  

The unknowns of the newer medications such as DPP-4 inhibitors and GLP-1 agonist are still out there. There is a hint of increased increased risk of pancreatitis.

The increased cost of newer medications is always a problem. The article suggest there may be some relief from the cost.
"In the United States, however, drug manufacturers offer discount cards for most branded combination pills, which reduces a patient's out-of-pocket costs to almost the same as that of adding a sulfonylurea to metformin. For example, monthly supplies of 2 dipeptidyl peptidase-4 (DPP-4)/metformin combinations -- Kombiglyze™ XR and Janumet® XR) are available for $10 or less with the manufacturer's discount card."

Please review my previous blogs for more details .


Diabetes medication , the first choice is easy, the second choice is not as easy


New Diabetes Meds= High Cost ! Hypoglycemia to the Rescue ?


Glucophage "failed " Now what should I do ?

Have fun , Be Smart and chose your diabetes medications carefully
David Calder,MD

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Your comments and questions are appreciated. David Calder,MD