Efficacy of Sulfonylureas

Sulfonylureas (SUs) have been available for the treatment of type 2 diabetes mellitus (T2DM) patients since 1950s and still occupy a central position in all international guidelines for diabetes management. With improved understanding of pathophysiology of T2DM and introduction of a number of newer oral agents, there is need to critically re-evaluate the effectiveness and safety of SUs, to assess their place in current management of T2DM. Sulfonylureas have the advantage of multiple formulations, low costs, minimal side effects, demonstrated efficacy in controlling hyperglycemia and reducing microvascular complications. However, recently concern has been raised with respect to their possible adverse effects. In addition to documented increase in risk of hypoglycemia, SUs are believed to favor the development b-cell apoptosis and b-cell exhaustion, endothelial dysfunction with increased risk for ischemic complications and possibly an increased mortality risk. This review attempts to analyze the advantages and disadvantages of available SUs with the purpose of providing a critical appraisal of the role of SUs in the modern treatment of T2DM.