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Review
. 2023 Apr 19:1-19.
doi: 10.1007/s13410-023-01192-6. Online ahead of print.

Time to reposition sulfonylureas in type 2 diabetes management in Indian context: A pragmatic practical approach

Ashok Kumar Das  1 , Banshi Saboo  2 , Rajeev Chawla  3 , S R Aravind  4 , Rajesh Rajput  5 , Awadhesh K Singh  6 , J J Mukherjee  7 , Ashok Jhingan  8 , Parag Shah  9 , Vaishali Deshmukh  10 , Shailaja Kale  11 , Shalini Jaggi  12 , G R Sridhar  13 , Rajnish Dhediya  14 , Kumar Gaurav  14
Affiliations
Review

Time to reposition sulfonylureas in type 2 diabetes management in Indian context: A pragmatic practical approach

Ashok Kumar Das et al. Int J Diabetes Dev Ctries. .

Abstract

Sulfonylureas (SU) continue to be a vital therapeutic category of oral hypoglycemic agents (OHAs) for the management of type 2 diabetes mellitus (T2DM). Physicians consider modern SU (gliclazide and glimepiride) as "safe and smart" choices for T2DM management. The presence of multiple international guidelines and scarcity of a national guideline may contribute to the challenges faced by few physicians in choosing the right therapeutic strategy. The role of SU in diabetes management is explicit, and the present consensus aims to emphasize the benefits and reposition SU in India. This pragmatic, practical approach aims to define expert recommendations for the physicians to improve caregivers' knowledge of the management of T2DM, leading to superior patient outcomes.

Keywords: Gliclazide; Glimepiride; Hypoglycemic agents; Sulfonylureas; Type 2 diabetes mellitus.

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Conflict of interest statement

Competing interestsAuthors AKD, BS, RC, SRA, RR, AKS, JJM, AJ, PS, VD, SK, SJ, and GRS are on the advisory board of Dr. Reddy`s Laboratories. Authors RD and KD are employees of Dr. Reddy`s Laboratories.

Figures

Fig. 1
Fig. 1
Metabolic fulcrum-based approach for T2DM patients. AGIs, alpha-glucosidase inhibitors; DPP4 inhibitor, dipeptidyl peptidase inhibitors; GLP1 RA, glucagon-like peptide-1 receptor agonist; SGLT2 inhibitors, sodium-glucose cotransporter-2 inhibitor. Sulfonylurea may be placed in the center of the fulcrum and can be used along with other OHAs to the left or right
Fig. 2
Fig. 2
SU in recent Diabetes Guideline: Country-wise diabetes guidelines (data from Refs. [, , –92]). DPP4, dipeptidyl peptidase 4; GLP-1 RA, glucagon-like peptide-1 receptor agonist; ICMR, Indian Council of Medical Research; IDF, International Diabetes Federation; MODY,,maturity-onset diabetes of the young (MODY); NICE, National Institute for Health and Care Excellence; OHA, oral hypoglycemic agent; RSSDI-ESI—Research Society for Study of Diabetes in India–Endocrine Society of India; SAFES, South Asian Federation of Endocrine Societies; SGLT2, sodium-glucose cotransporter-2; SU, sulfonylurea; TZD, thiazolidinediones; WHO, World Health Organization
Fig. 3
Fig. 3
Gliclazide dose initiation and titration. Source: NHS Buckinghamshire Guide to Prescribing and Titrating Gliclazide Therapy. Abbreviations: BID, twice daily; FPG, fasting plasma glucose; HbA1c, glycated hemoglobin; OD, once daily; PPG, postprandial plasma glucose
See this image and copyright information in PMC

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