The effect of sulphonylureas on the microvascular and macrovascular complications of diabetes.
BACKGROUND
Type 2 diabetes mellitus is a chronic progressive disease that is characterised by hyperglycaemia and is associated with an increased risk of the development of microvascular complications, such as retinopathy, nephropathy and neuropathy, and cardiovascular disease. With the introduction of newer oral hypoglycaemic agents, there is a need to re-evaluate critically the effectiveness and safety of the older agents, including sulphonylureas, to assess their place in the modern management of type 2 diabetes.


BACKGROUND
Though no clear benefit of sulphonylureas has been shown with respect to large vessel disease, long term studies have, however, shown benefits in patients with microvascular complications. Studies such as the University Group Diabetes Project raised concerns about the safety profile of sulphonylureas, but large prospective studies such as the UK Prospective Diabetes Study have helped to assuage such concerns to a large degree. Their utility in the peri-infarct period continues to be debatable because of the potential effect on cardiac pre-conditioning.


CONCLUSIONS
Though sulphonylureas continue to be a mainstay of treatment in type 2 diabetes, future clinical trials addressing clinically relevant outcomes are indicated with the newer generation of sulphonylureas that are more beta cell-specific to address the concerns raised about sulphonylureas and cardiac myocytes.
Kar
Partha
P
Development Origins of Health and Disease Division, School of Medicine, University of Southampton, Southampton, UK.
Holt
Richard I G
RI
D000818:Animals; D003925:Diabetic Angiopathies / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008833:Microcirculation / Q000187:drug effects* / Q000473:pathology; D013453:Sulfonylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use*
D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds