Original ArticleContemporary Analysis of Secondary Failure of Successful Sulfonylurea Therapy
Section snippets
INTRODUCTION
Much of what is known about the long-term success of sulfonylurea (SU) therapy in achieving and maintaining glycemic control is based on data obtained from clinical trials or from older observational reports 1., 2.. The SU class of antihyperglycemic medications has been used as first-line oral agent therapy for type 2 diabetes since 1954 (3). For many years, SUs were the only noninsulin option in the United States, but the therapeutic landscape changed in 1995 with the release of metformin.
PATIENTS AND METHODS
The current study was conducted within the Kaiser Permanente Northwest (KPNW) health care organization, which has approximately 480,000 members in northwest Oregon and southwest Washington. A single regional laboratory performs all KPNW laboratory tests, and the results are stored in a searchable electronic database. A pharmacy is located in each medical office, and most members have a pharmacy benefit, helping to ensure complete capture of pharmaceutical medications dispensed.
DISCUSSION
The documented benefits of glycemic control 16., 17., 18. have motivated the adoption of substantially lower A1C targets than were in place 10 years ago, when SU was the only orally administered agent available in the United States. Oral agent options have since expanded; newer agents may have some advantage over SU. Metformin therapy is often recommended for obese patients with type 2 diabetes because it does not cause hypoglycemia and frequently results in modest weight loss, rather than
CONCLUSION
The natural history of type 2 diabetes is often slow, progressive beta cell failure. Do those patients with lower posttreatment A1C levels currently have better beta cell function than those with slightly higher A1C values? Will those patients with lower posttreatment A1C values show loss of beta cell function and higher A1C levels with a longer period of observation? Does type of treatment prescribed affect long-term outcomes? Additional research is required to provide answers to these
DISCLOSURE
Drs. Alexander, Girman, and Kamal-Bahl are employees of Merck. They assisted with conceptualizing the study design but did not participate in the conduct of the study. Merck did not participate in collection, management, or analysis of data. The Merck coauthors assisted with interpretation of the results. Although the manuscript was prepared by Dr. Nichols, who is not employed by Merck, the Merck coauthors offered editing suggestions, and the final manuscript was reviewed by Merck. By contract,
ACKNOWLEDGMENT
This study was supported by a research grant from Merck & Co., Inc.
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Cited by (17)
Management of type 2 diabetes without insulin: An update for the PCP
2022, Disease-a-MonthCitation Excerpt :Meglitinides (e.g., repaglinide, nateglinide) are short-acting insulin secretagogues that reduce the HbA1c by about 1%. A secondary failure to oral hypoglycemic agent (OHA) is said to occur when a sulfonylurea (and metformin), in appropriate doses and diet, loses its capacity to produce a desired maximal therapeutic effect (FBG < 8.0 mmol/L or HBA1c < 7.0%) after administration in the absence of other conditions causing hyperglycemia.47 Some studies showed that sulfonylurea use may be associated with a secondary failure rate that may exceed other drugs due to an exacerbation of islet dysfunction.48
Progression to treatment failure among Chinese patients with type 2 diabetes initiated on metformin versus sulphonylurea monotherapy-The Hong Kong Diabetes Registry
2016, Diabetes Research and Clinical PracticeCitation Excerpt :In that study, the mean annual failure rate for metformin monotherapy was 17%, and 12.2% for those patients who were initiated on metformin within 3 months of diagnosis. Regarding SU, a secondary failure rate of 21.8% was reported based on a one-year follow-up study [23], whilst Nichols et al. [24] concluded that the secondary failure rate of SU was inversely associated with the level of HbA1c achieved within the first year of SU monotherapy, with an annual failure rate of ∼15% for those patients who achieved a HbA1c between 7.5% (58 mmol/mol) to 7.9% (63 mmol/mol) within 1 year of initiating treatment. The failure rate is likely to differ between studies depending on the definition of treatment failure, as well as the endogenous beta-cell function and insulin resistance of the subjects recruited in the studies.
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2015, American Journal of Managed CareIntensification of antihyperglycemic therapy among patients with incident diabetes: A Surveillance Prevention and Management of Diabetes Mellitus (SUPREME-DM) study
2014, Pharmacoepidemiology and Drug SafetyChanges in pharmaceutical treatment of diabetes and family financial burdens
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