Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-42

Table 6. Insulin secretagogues: Sulfonylureas (13, 24,38,42,43,94-100) Insulin secretagogues : Sulfonylureas Therapeutic Considerations Mechanism of action

Adverse Effects • Lack durability in blood glucose lowering. • Associated with significant risks of hypoglycemia (annual rate 20%): o moderate 20% - 40% o severe 1–7% • Weight gain 1.2 to 3.2 kg • Concerns about CV safety of the class. • Conflicting evidence: increase risk of CV mortality and major cardiac events (acute MI, congestive heart failure, stroke). Considerations in the elderly • Should be used with caution as risk of severe hypoglycemia significantly increases with age. • Gliclazide and glimepiride can be used. ** Important to review Driving Guidelines in all individuals taking sulfonylureas in order to minimize risk of hypoglycemia. ** Important to review Sick-Day Management in all individuals taking sulfonylureas. Refer to “ Antihyperglycemic agents and sick-day medication list” found later in this chapter

• Activates the sulfonylurea receptor on beta cells stimulating endogenous insulin secretion. • Second-generation sulfonylureas are preferred, due to their increased effectiveness, decreased side effects and drug-drug interaction. They are also less likely to cause hypoglycemia than first-generation sulfonylureas. Benefits • ↓ A1C 0.6-1.2 % • Rapid lowering of BG levels. • Post-prandial BG lowering especially with meglitinides.