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Diabetes Care, Vol 15, Issue 6 737-754, Copyright © 1992 by American Diabetes Association
Sulfonylureas in NIDDM
LC Groop
Fourth Department of Medicine, Helsinki University Hospital, Finland.
Sulfonylureas have represented the backbone of oral therapy in
non-insulin-dependent diabetes mellitus for greater than 30 yr. Despite
this, our knowledge about the mode of actions of these agents is limited,
and the use of them is far from rational. Sulfonylureas lower blood glucose
concentrations primarily by stimulating insulin secretion. The evidence for
clinically significant extrapancreatic effects is scanty. Therefore, the
effect of sulfonylurea is limited to patients with preserved beta-cell
function, with the best effect observed in the early stages of the disease.
Sulfonylurea treatment is often started relatively late and is continued
when the agents can no longer achieve the treatment goals. Drug dosages are
increased to maximum recommended doses, although there is no evidence for a
dose-response relationship between the sulfonylurea dose and its biological
effect. To rationalize the use of sulfonylureas, we should ask the
questions to whom, how much, and for how long? The decision to stop
treatment is as important as the decision to start treatment.

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Copyright © 1992 by the American Diabetes Association.
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