Glyburide, gliclazide, or glimepiride for elderly patients with type 2 diabetes a review of the clinical effectiveness and safety - an update
Thus far, only limited evidence regarding the comparative effects of these drugs in the elderly has been synthesized and recent concerns regarding the cardiovascular effects of these drugs have been noted. Thus, this update will expand on the work of the previous CADTH reports to further investigate...
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| Format: | eBook |
| Language: | English |
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[Ottawa]
Canadian Agency for Drugs and Technologies in Health
18 August 2015, 2015
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| Series: | Rapid response report: summary with critical appraisal
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| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | Thus far, only limited evidence regarding the comparative effects of these drugs in the elderly has been synthesized and recent concerns regarding the cardiovascular effects of these drugs have been noted. Thus, this update will expand on the work of the previous CADTH reports to further investigate the comparative clinical efficacy and safety of these medications in older persons Sulfonylureas are a class of glucose lowering drugs used to treat type 2 diabetes. These drugs bind to sulfonylurea receptors and stimulate closure of adenosine triphosphate sensitive potassium channels to encourage insulin secretion from pancreatic beta cells. Glyburide (also referred to as glibenclamide), gliclazide, and glimepiride are three second-generation sulfonylurea drugs available in Canada. Glyburide has been associated with an increased risk for hypoglycemia and long-term cardiovascular mortality. This may be due to differences in tissue-specific binding of the respective sulfonylureas. A meta-analysis published in 2007 reported an increased risk of hypoglycemia for glyburide compared to other insulin secreting anti-diabetes drugs and alternate sulfonylureas, despite no evidence of improved efficacy. Hypoglycemia can lead to undesirable outcomes including altered mental status, seizures, coma and death. It is more strongly associated with the use of long-acting sulfonylureas (e.g., glyburide and glimepiride) than short-acting sulfonylureas (e.g., gliclazide). The American Geriatrics Society's Beers Criteria lists a strong recommendation based on high quality evidence that glyburide be avoided in the elderly due to the potential risks. Based on US market pricing, gliclazide is three times higher in price than glyburide, which may contribute to the persistent use of glyburide. A previous CADTH review of literature published from 2007 to 2011 reported that there was no evidence regarding the comparative clinical effectiveness of these agents in the elderly, and limited evidence regarding safety, based on the results of two non-randomized studies. One included study reported greater all-cause mortality associated with glyburide use versus gliclazide, and the other reported a numerically higher occurrence of hypoglycemia among patients taking glyburide monotherapy. |
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| Item Description: | Title from PDF caption title |
| Physical Description: | 1 PDF file (23 pages) illustrations |