Current Status of Sulphonylureas after CAROLINA and CARMELINA Trial - Maximum Glycemic Efficacy with Cardiac Safety

Sulfonylureas (SU) are one of the most used antidiabetic medications mainly due to their cost-effectiveness and reduced frequency of dosing. They have a therapeutic effect in patients with adequate β cell function. SU were rst discovered in 1942 by Janbon who observedthat some sulfonamides generated hypoglycemia in experimental animals. Carbutamide wasthe rst sulfonylurea which was discovered and used to treat diabetes, but was subsequentlywithdrawn from the market because of damage to the bone marrow. By the 1960s several SU became available; they were classied into 2 generations. Gliclazide, Glipizide, Glibenclamideand Glimepiride are second-generation sulfonylureas, currently used, while rst-generation drugs
(such as Tolbutamide and Chlorpropamide) are no longer used due to their adverse cardiovascular prole. Second generation drugs are as effective as rst-generation drugs to lower the blood glucose concentrations, but there are differences in absorption, metabolism and dosing