Exploring the role of sulfonylureas in the treatment of non-insulin-dependent diabetes mellitus.

For the last 30 years, sulfonylureas have been the mainstay of treatment for patients with non-insulin-dependent diabetes mellitus (NIDDM). They offered patients an alternative to using insulin to lower their blood glucose. One of the advantages of these agents was that they could be taken orally as opposed to insulin, which required multiple daily injections. In addition, they are tolerable, with few side effects, and they cause less hypoglycemia than does insulin. In the past year, new agents (metformin and acarbose) have been introduced into the market and have offered practitioners an alternative to the traditional sulfonylureas. The sulfonylureas are still valuable agents in the treatment of NIDDM. Their efficacy is unsurpassed by any other oral medications. They possess the best tolerability profile of all oral agents on the market, and they possess very few contraindications or drug interactions. The sulfonylureas should still be considered first-line agents for NIDDM. Metformin and acarbose are agents that may benefit a specific patient population, but sulfonylureas are agents that can benefit most patients.