June 4, 2013
Pills for Diabetes, Type 2
Question from India:
At the age of 53, I am 5 feet, 7 inches tall. My blood sugars are between 200 and 250 mg/dl [11.1 and 13.9 mmol/L]. Controlling my diet did not work, nor did metformin. For eight years, I have been taking acarabose and voglibose but they have been upsetting my stomach. So, I now need to take a sulfonylurea. I have VPC (ventricular premature contraction). Which is better for me, glimepiride (1 mg) or gliclazide (30 mg film coated) or dpp-4 (dipeptidyl peptidase 4)?
Answer:
Sulfonylureas are not necessarily a first-line drug. However, they do have their place in the treatment of type 2 diabetes. They are inexpensive and do work. Of the ones you noted, I prefer glimepiride over gliclazide. There is a theoretical benefit to the glimepiride having less cross-reactivity with the heart. The dpp-4 inhibitors are very expensive and not very potent. Although this might be helpful to some, if your HbA1c is 1% over target, the dpp-4 might not be potent enough to bring down to target.
JTL
