Glimepiride: evidence-based facts, trends, and observations (GIFTS). [corrected]

Abstract

Type 2 diabetes mellitus is characterized by insulin resistance and progressive β cell failure; therefore, β cell secretagogues are useful for achieving sufficient glycemic control. Glimepiride is a second-generation sulfonylurea that stimulates pancreatic β cells to release insulin. Additionally, is has been shown to work via several extra pancreatic mechanisms. It is administered as monotherapy in patients with type 2 diabetes mellitus in whom glycemic control is not achieved by dietary and lifestyle modifications. It can also be combined with other antihyperglycemic agents, including metformin and insulin, in patients who are not adequately controlled by sulfonylureas alone. The effective dosage range is 1 to 8 mg/day; however, there is no significant difference between 4 and 8 mg/day, but it should be used with caution in the elderly and in patients with renal or hepatic disease. In clinical studies, glimepiride was generally associated with lower risk of hypoglycemia and less weight gain compared to other sulfonylureas. Glimepiride use may be safer in patients with cardiovascular disease because of its lack of detrimental effects on ischemic preconditioning. It is effective in reducing fasting plasma glucose, post-prandial glucose, and glycosylated hemoglobin levels and is a useful, cost-effective treatment option for managing type 2 diabetes mellitus.

Keywords: antihyperglycemic agents; diabetes; glimepiride; sulfonylurea.

Figure 1

Management of hyperglycemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association and the European Association for the Study of Diabetes. © 2012, Springer Science and Business Media. Reproduced with kind permission from Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2012;55(6):1577–1596. Abbreviations: DPP-4, dipeptidyl peptidase IV; GIP, glucose-dependent insulinotropic peptide; GLP-1, glucagon-like peptide 1; NPH, neutral protamine Hagedorn; TZD, thiazolidinedione.

Figure 2

International Diabetes Federation treatment algorithm for people with type 2 diabetes. © 2005, International Diabetes Federation. Reproduced with kind permission from International Diabetes Federation Clinical Guidelines Task Force. Global guidelines for type 2 diabetes. 2005. Available from: http://www.idf.org/Global_guideline. Accessed on March 29, 2012.

Figure 3

Chemical structure of glimepiride.