Lebovitz H E
Am J Med. 1983 Nov 30;75(5B):94-9. doi: 10.1016/0002-9343(83)90259-0.
Clinical usage of the sulfonylurea drugs is based on experience in well-controlled long-term studies in large numbers of patients. The results of such studies indicate that approximately 60 to 70 percent of the patients with noninsulin-dependent diabetes mellitus of recent onset will respond initially to sulfonylurea therapy with satisfactory control of glycemia, about 15 to 20 percent will not respond initially (primary failures), and another 15 to 20 percent who respond initially will lose their responsiveness during the first few years of treatment (secondary failures). In extensive studies in small numbers of patients, we found that successful management of noninsulin-dependent diabetes mellitus with glipizide was correlated with increased insulin responsiveness and that patients who did not have an increase in their insulin-mediated glucose disposal during glipizide therapy were primary failures. Successful treatment of noninsulin-dependent diabetes mellitus with sulfonylureas is associated with onset of of the disease at 40 years of age or later, normal or increased body weight, duration of disease less than five years, and a history of either no previous insulin therapy or therapy with less than 20 units of insulin per day. The use of specific sulfonylurea drugs is predicated on differences in their metabolism, side effects, and perhaps potency.
磺脲类药物的临床应用基于对大量患者进行的长期严格控制研究的经验。此类研究结果表明，大约60%至70%的近期发病的非胰岛素依赖型糖尿病患者最初对磺脲类药物治疗有反应，血糖得到满意控制；约15%至20%的患者最初无反应（原发性失效）；另有15%至20%最初有反应的患者在治疗的最初几年会失去反应性（继发性失效）。在对少数患者进行的广泛研究中，我们发现用格列吡嗪成功治疗非胰岛素依赖型糖尿病与胰岛素反应性增加相关，并且在格列吡嗪治疗期间胰岛素介导的葡萄糖处理未增加的患者为原发性失效。用磺脲类药物成功治疗非胰岛素依赖型糖尿病与以下因素有关：发病年龄在40岁或之后、体重正常或增加、病程少于5年、既往无胰岛素治疗史或每日胰岛素治疗量少于20单位。特定磺脲类药物的使用取决于它们在代谢、副作用以及可能的效力方面的差异。
