Abstract

SULFONYLUREAS: A REVIEW OF THEIR SAFETY

Krishna G. Seshadri*

.

Abstract

Sulfonylureas (SU) were introduced into clinical care in the middle of the previous century. Three generations of SU have been available in clinical care. They work by increasing insulin secretion by the beta cells through their action on Sulfonylurea Receptors (SUR). SUR subtypes have differential expression in the heart and beta cells. Differing affinity of different SU to SUR subtypes may explain differences in tissue selectivity. SU reduce hbA1c up to 1.5%. Major adverse effects include hypoglycemia and modest weight gain. Hypoglycemia is of particular concern in combination with insulin and in the presence of renal dysfunction. Concerns about the cardiovascular safety of these agents have persisted since the sixties. Overall, the newer generation SU appear to be safe based on available randomized control trials and meta- analysis. Less clear is their effect on risk of arrhythmias and heart failure. Despite the availability of newer medications, SU continue to be an important part of the clinical care of diabetes.

Keywords: Sulfonylurea, side effect, efficacy, safety.