Case Western Reserve University, Cleveland, OH
Diabetes Care. 2015 Jan;38(1):170-5. doi: 10.2337/dc14-0565.
Since their introduction to clinical practice in the 1950s, sulfonylureas have been widely prescribed for use in patients with type 2 diabetes. Of all the other medications currently available for clinical use, only metformin has been used more frequently. However, several new drug classes have emerged that are reported to have equal glucose-lowering efficacy and greater safety when added to treatment of patients in whom metformin monotherapy is no longer sufficient. Moreover, current arguments also suggest that the alternative drugs may be superior to sulfonylureas with regard to the risk of cardiovascular complications. Thus, while there is universal agreement that metformin should remain the first-line pharmacologic therapy for those in whom lifestyle modification is insufficient to control hyperglycemia, there is no consensus as to which drug should be added to metformin. Therefore, given the current controversy, we provide a Point-Counterpoint on this issue. In the preceding point narrative, Dr. Abrahamson provides his argument suggesting that avoiding use of sulfonylureas as a class of medication as an add-on to metformin is not appropriate as there are many patients whose glycemic control would improve with use of these drugs with minimal risk of adverse events. In the counterpoint narrative below, Dr. Genuth suggests there is no longer a need for sulfonylureas to remain a first-line addition to metformin for those patients whose clinical characteristics are appropriate and whose health insurance and/or financial resources make an alternative drug affordable.
自 20 世纪 50 年代引入临床实践以来，磺酰脲类药物已被广泛用于治疗 2 型糖尿病患者。在目前可用于临床的所有其他药物中，只有二甲双胍的使用更为频繁。然而，已经出现了几种新的药物类别，据报道，当添加到二甲双胍单药治疗不再足够的患者中时，它们具有同等的降血糖效果和更高的安全性。此外，目前的论点还表明，与磺酰脲类药物相比，替代药物可能在心血管并发症风险方面具有优势。因此，虽然普遍认为二甲双胍仍然是生活方式改变不足以控制高血糖患者的一线药物治疗，但对于应该添加哪种药物尚无共识。因此，鉴于目前的争议，我们就此问题提供了一个观点对比。在前一点的叙述中，Abrahamson 博士提出了他的观点，即避免将磺酰脲类药物作为二甲双胍的附加药物类别使用是不合适的，因为有许多患者的血糖控制可以通过使用这些药物得到改善，而不良反应的风险最小。在下面的反驳叙述中，Genuth 博士认为，对于那些临床特征合适、医疗保险和/或经济资源允许使用替代药物的患者来说，磺酰脲类药物不再需要作为二甲双胍的一线附加药物。
