DMSI and CeSI-Met, University of Chieti, Chieti, Italy.
Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
Diabetes Obes Metab. 2020 Oct;22(10):1705-1713. doi: 10.1111/dom.14102. Epub 2020 Jul 5.
The large number of pharmacological agents available to treat type 2 diabetes (T2D) makes choosing the optimal drug for any given patient a complex task. Because newer agents offer several advantages, whether and when sulphonylureas (SUs) should still be used to treat T2D is controversial. Published treatment guidelines and recommendations should govern the general approach to diabetes management. However, expert opinions can aid in better understanding local practices and in formulating individual choices. The current consensus paper aims to provide additional guidance on the use of SUs in T2D. We summarize current local treatment guidelines in European countries, showing that SUs are still widely proposed as second-line treatment after metformin and are often ranked at the same level as newer glucose-lowering medications. Strong evidence now shows that sodium-glucose co-transporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are associated with low hypoglycaemia risk, promote weight loss, and exert a positive impact on vascular, cardiac and renal endpoints. Thus, using SUs in place of SGLT-2is and GLP-1RAs may deprive patients of key advantages and potentially important cardiorenal benefits. In subjects with ascertained cardiovascular disease or at very high cardiovascular risk, SGLT-2is and/or GLP-1RAs should be used as part of diabetes management, in the absence of contraindications. Routine utilization of SUs as second-line agents continues to be acceptable in resource-constrained settings.
有大量的药理学药物可用于治疗 2 型糖尿病（T2D），因此为任何特定患者选择最佳药物都是一项复杂的任务。由于新型药物具有多种优势，磺酰脲类药物（SUs）是否仍应用于治疗 T2D 存在争议。已发布的治疗指南和建议应指导糖尿病管理的一般方法。然而，专家意见有助于更好地了解当地的实践，并制定个人选择。本共识文件旨在就 SUs 在 T2D 中的应用提供额外的指导。我们总结了欧洲国家目前的当地治疗指南，表明 SUs 仍然广泛作为二甲双胍后的二线治疗药物，并且通常与新型降糖药物处于同一水平。目前有强有力的证据表明，钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2is）和胰高血糖素样肽-1 受体激动剂（GLP-1RAs）低血糖风险低，可促进体重减轻，并对血管、心脏和肾脏终点产生积极影响。因此，用 SUs 替代 SGLT-2is 和 GLP-1RAs 可能会使患者失去关键优势和潜在的重要心脏肾脏益处。在有明确心血管疾病或极高心血管风险的患者中，应在无禁忌症的情况下将 SGLT-2is 和/或 GLP-1RAs 用于糖尿病管理的一部分。在资源有限的情况下，继续将 SUs 常规用作二线药物仍然是可以接受的。
