General practice Terapia 2022, 5 ( 412 ) : 108 - 117
Current management of type 2 diabetes. The role of sulfonylureas in modern pharmacotherapy
Summary:
The article is about the principles of management of type 2 diabetes, the most common metabolic disease in the world. Although diabetes is characterized by the typical clinical symptoms of hyperglycaemia, it is sometimes asymptomatic, especially at the beginning of the disease. Therefore, screening strategies are very important, because untreated or poorly treated type 2 diabetes leads to the development of chronic microvascular and macrovascular complications. The most important and the most difficult to implement "drug" is non-pharmacological treatment. Due to the complex pathomechanism of the disease, in the treatment of type 2 diabetes, drugs with different mechanisms of action are used, arranged due to the chronic, progressive nature of the disease - in the treatment intensification algorithm, ranging from metformin to complex insulin therapy. Some GLP1-1 analogs and some SGLT-2 inhibitors have proven to be beneficial in reducing cardiovascular risk; they should be used in patients with pre-existing vascular complications and in patients with cardiovascular risk factors from the beginning of therapy and then - regardless of the degree of metabolic control (monitored, for example, with HbA1c). For many years, sulfonylureas (SUs) have been - after metformin - the most frequently prescribed antidiabetic drugs in primary health care and diabetes clinics. Due to many years of experience, the well-known efficacy and safety profile they remain widely used in Poland and other countries - both as a "second-line" drug added to metformin, in monotherapy (when metformin is not tolerated or there are contraindications to it), as well as in triple therapy (with metformin and SGLT-2 inhibitor). Gliclazide is the most studied drug, it has the lowest risk of inducing hypoglycaemia among the whole group of SUs, and it is also attractive in terms of treatment costs.
Keywords: diabetes, screening strategies, hyperglycaemia, hypoglycaemia, blood glucose monitoring, antidiabetic drugs, sulfonyloureas
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