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Glimepiride in the medical management of Type 2 diabetes

Type 2 diabetes mellitus, a disorder of impaired insulin secretion and insulin resistance, has reached epidemic proportions.// The identification of high-risk individuals and lifestyle management can help control diabetes; however, most patients require pharmacologic intervention.

To achieve glycemic control, a stepwise treatment approach has generally been used, beginning with a program of diet and exercise, and to minimize the risk of future micro- and macrovascular complications.

Oral agents, with or without insulin, are added when diet and exercise fail to normalize glucose levels. Various pharmacologic agents are available for the management of Type 2 diabetes, including first- and second-generation sulfonylureas (glimepiride, glipizide, and glyburide), biguanides (metformin), á-glucosidase inhibitors (acarbose and miglitol), thiazolidinediones (pioglitazone and rosiglitazone), meglitinide analogues (repaglinide), amino acid D-phenylalanine derivatives (nateglinide), and insulin.

A recent article, presented in vol 18 (6) of Journal of Diabetes and its Complications reviews the role of the sulfonylureas - with a major focus on glimepiride, the newest of the second-generation sulfonylureas - in the medical management of Type 2 diabetes.

The sulfonylureas, the first oral agents introduced for the management of Type 2 diabetes, are effective, well-tolerated, and well-established drugs; Second-generation sulfonylureas are now widely used in the management of Type 2 diabetes. The most recent addition, glimepiride, can be used in combination with metformin, the thiazolidinediones, a-glucosidase inhibitors, and insulin. The unique properties of glimepiride may provide advantages over other currently available insulin secretagogues.

Type 2 diabetes mellitus can lead to serious long-term sequelae, such as blindness, kidney failure, heart disease, neurologic impairment, and stroke. Stringent lifestyle modifications, in
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