The effect on metabolic control of second-generation sulfonylurea drugs in patients with NIDDM after secondary failure to first-generation agents.
BACKGROUND
The literature contains few data examining the results of therapy with second-generation sulfonylurea drugs in subjects with non-insulin-dependent diabetes mellitus (NIDDM) after the onset of secondary failure to first-generation agents. The present study was undertaken to assess the efficacy of therapy with second-generation sulfonylurea in subjects with NIDDM following secondary failure to first-generation agents.


METHODS
The study included 55 subjects with NIDDM who manifested secondary failure to first-generation sulfonylurea therapy. Of these, 29 subjects underwent therapy with the second-generation sulfonylurea glipizide, and 26 subjects were treated with glyburide, both drugs administered in the maximum daily dosage. Before initiation of the second-generation sulfonylurea agents and again at the end of 6 months, metabolic control was assessed by determination of fasting plasma glucose, glycosylated hemoglobin (HbA1c), and the lipid profile.


RESULTS
Fasting plasma glucose and HbA1c levels were 209 +/- 31 mg/dL and 12.3 +/- 2.1%, respectively, before initiation of glipizide, and did not significantly change following therapy (fasting plasma glucose, 211 +/- 34 mg/dL; HbA1c, 11.7 +/- 1.8%). Similarly, no significant alteration was noted in these metabolic values in the glyburide group (before glyburide therapy, fasting plasma glucose, 180 +/- 16 mg/dL; HbA1c, 11.2 +/- 1.6%; after glyburide therapy, fasting plasma glucose, 184 +/- 20 mg/dL; HbA1c, 11.0 +/- 1.5%). Lipids also were not significantly altered following therapy with either glipizide or glyburide. Finally, for all subjects, fasting plasma glucose and HbA1c were 200 +/- 27 mg/dL and 11.9 +/- 2.0%, respectively, during treatment with first-generation drugs and did not change significantly following therapy with the second-generation agents (fasting plasma glucose, 205 +/- 20 mg/dL; HbA1c, 11.2 +/- 1.2%). P values were > .60 for all comparisons.


CONCLUSIONS
Treatment with second-generation sulfonylurea agents for patients with NIDDM following onset of secondary failure to first-generation sulfonylurea drugs achieves no better metabolic control than treatment with first-generation agents.
Sami
T
T
VA Medical Center, Phoenix, AZ 85012, USA.
Kabadi
U M
UM
Moshiri
S
S
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001835:Body Weight / Q000187:drug effects; D002784:Cholesterol / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D013453:Sulfonylurea Compounds / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D017211:Treatment Failure; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D002784:Cholesterol; D006442:Glycated Hemoglobin; D013453:Sulfonylurea Compounds; D014280:Triglycerides