Mohan Viswanathan, Saboo Banshi, Khader Jabbar, Modi Kirtikumar D, Jindal Sushil, Wangnoo Subhash Kumar, Amarnath Sugumaran
Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India.
Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India.
Clin Med Insights Endocrinol Diabetes. 2022 Feb 14;15:11795514221074663. doi: 10.1177/11795514221074663. eCollection 2022.
Sulfonylureas (SUs) are one of the commonly prescribed oral anti-hyperglycemic agents (AHA) in low- and middle-income countries (LMICs), either in combination with metformin therapy or alone. However, concern about cardiovascular safety has limited the use of SUs in the management of type 2 diabetes mellitus (T2DM). Additionally, lack of uniformity in the national and international guidelines regarding the positioning of SUs in the management of diabetes has also been reported. The objective of this review was to assess the various national and international guidelines on diabetes management and understand the recommendations specific to SUs in various scenarios. A total of 33 national and international guidelines on the management of T2DM published in English were evaluated. These guidelines have considered the latest evidence and suggest the use of certain second-generation SUs as second-line therapy or in combination with other AHAs in select population and specific scenarios. Identification of the appropriate population, classification based on underlying risk, thorough assessment of the comorbid conditions, and a step-wise approach for the selection of appropriate SUs is essential for the effective management of T2DM. Additionally, cost-to-benefit ratio should be considered, particularly in LMICs, and SUs could continue to play an important role in such settings.
磺脲类药物（SUs）是低收入和中等收入国家（LMICs）常用的口服降糖药（AHA）之一，可与二甲双胍联合使用或单独使用。然而，对心血管安全性的担忧限制了SUs在2型糖尿病（T2DM）管理中的应用。此外，也有报道称，国家和国际指南在SUs在糖尿病管理中的定位方面缺乏一致性。本综述的目的是评估各种国家和国际糖尿病管理指南，并了解在各种情况下针对SUs的具体建议。共评估了33份以英文发表的关于T2DM管理的国家和国际指南。这些指南考虑了最新证据，并建议在特定人群和特定情况下，将某些第二代SUs用作二线治疗或与其他AHA联合使用。识别合适的人群、根据潜在风险进行分类、全面评估合并症以及采用逐步方法选择合适的SUs对于T2DM的有效管理至关重要。此外，应考虑成本效益比，特别是在低收入和中等收入国家，SUs在这些环境中可能继续发挥重要作用。
