Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-43

Gliclazide (Diamicron® MR) • Gliclazide preferred over glimepiride and glyburide due to the lower risk of hypoglycemia, CV events and mortality. • TDD: 30 mg - 120 mg • Frequency: QD • Taken with breakfast or first meal. Dose • Initiate with 30 mg QD • Titrate 30 mg every 2 weeks. • Tablets should be swallowed whole, not broken or chewed. • Available: 30 mg, 60 mg ------------------------------------------------------

Caution •

Consider lower dose if eGFR <45 mL/min/1.73m 2 due to increased risk of hypoglycemia.

Considerations in the elderly •

Initiate at half usual starting dose.

Slower dose titration.

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Gliclazide (Diamicron®) • TDD: 80 mg - 320 mg • Frequency: QD/BID • Taken with meals. Dose •

Initiate with 80 mg QD or BID.

Titrate every 1–2 weeks.

• •

Available: 80 mg

Glimepiride (Amaryl®) • TDD: 1 mg - 8 mg • Frequency: QD • Taken with breakfast or first meal. Dose • Initiate therapy at 1 mg QD. • Titrate dose by 1mg every 1–2 weeks. Benefits • less hypoglycemia compared to glyburide (24). • Rapid onset and long duration of action. • Can be used safely in mild to severe renal impairment. • Available: 1 mg, 2 mg, 4 mg • Demonstrated CV safety similar to DPP-4i (linagliptin) in CAROLINA trial • •

Metabolized in liver

Eliminated: 60% urine, 40% feces

Caution •

Consider lower dose if eGFR <45 mL/min/1.73m 2 due to increased risk of hypoglycemia.

Considerations in the elderly • Initiate at lowest dose. • Slow dose titration.