Note:Bracketed information in the Indications section refers to uses that are not included in the Australian approved product information.¶ Accepted
Diabetes mellitus, type 2 (treatment)Sulfonylureas are indicated as adjunctive therapy to diet and exercise in the treatment and control of patients with type 2 diabetes mellitus (previously known as non-insulin-dependent diabetes mellitus [NIDDM], adult-onset diabetes, maturity-onset diabetes), which occurs in individuals who produce or secrete insufficient quantities of endogenous insulin or who have developed resistance to endogenous insulin. An attempt to control diabetes through changes in diet and level of physical activity is usually first-line management before beginning pharmacologic treatment. Those patients not responding adequately to diet alone, or those patients requiring diet plus insulin, especially if they require 40 units or less of insulin a day, may be candidates for therapy with a sulfonylurea as monotherapy or combination therapy.
Short-term administration of a sulfonylurea or insulin for transient loss of blood glucose control may be sufficient for patients with type 2 diabetes mellitus normally well controlled with diet. Switching to another sulfonylurea agent may be beneficial if one particular sulfonylurea does not optimally control the diabetes mellitus; however, use of a sulfonylurea should be discontinued if satisfactory reduction of blood glucose concentration is not achieved.
Combination use of insulin and sulfonylurea agents in patients with type 1 diabetes mellitus (insulin-dependent diabetes mellitus [IDDM]) is controversial because many studies have indicated that sulfonylureas are not effective in the treatment of these patients.
[Sulfonylureas are used in the treatment of diabetes mellitus associated with endocrine disease, including endocrine overactivity due to Cushing's syndrome, hyperthyroidism, phaeochromocytoma, somatostatinoma, or aldosteronoma; or endocrine underactivity due to hypoparathyroidism-hypocalcaemia, type 1 isolated growth hormone deficiency, or multitropic pituitary deficiency.]
[Sulfonylureas are used in the treatment of diabetes mellitus associated with genetic syndromes, including, inborn errors of metabolism (such as glycogen-storage disease type 1) or insulin-resistant syndromes (such as muscular dystrophies, late onset proximal myopathy, or Huntington's chorea).]
[Sulfonylureas may be used in conditions causing diabetes mellitus induced by hormones, medications, or chemicals in patients who have functioning pancreatic beta cells when the diabetes cannot be controlled by diet or exercise.]
The effectiveness of sulfonylureas in controlling blood glucose can decrease over time. If maximum doses of a sulfonylurea fail to control blood glucose, switching to another sulfonylurea or adding metformin to a sulfonylurea treatment regimen may be beneficial in increasing glycaemic control and lipoprotein metabolism, and to help avoid initiation of insulin therapy. This is especially successful in patients with type 2 diabetes mellitus poorly controlled by insulin alone, in short-term diabetics, or in patients who are 20 to 60% over ideal baseline body weight but who are not excessively insulin-resistant. Alternatively, low-dose insulin in conjunction with sulfonylureas can help to avoid using large doses of insulin, especially for obese type 2 diabetes mellitus patients; however, complications, such as weight gain, the effects of hyperinsulinaemia, and an increased risk of hypoglycaemia need to be considered. Some non-obese type 2 diabetes mellitus patients experiencing secondary sulfonylurea failure may be best treated with insulin. A sulfonylurea should be discontinued anytime it fails to contribute to the lowering of plasma glucose in a patient for whom compliance with proper diet and sulfonylurea dosing has been determined to be adequate.
Sulfonylureas are not effective in the treatment of type 1 diabetes mellitus (insulin-dependent diabetes mellitus [IDDM]).