What is the use of glimepiride (a sulfonylurea oral hypoglycemic agent)?

From the Guidelines

Glimepiride should be used with caution in patients with type 2 diabetes, as it has a high risk of hypoglycemia and weight gain, but it can be effective in lowering blood sugar levels, especially when combined with metformin or other medications, as recommended by the most recent guidelines 1.

Key Considerations

• Glimepiride is an oral sulfonylurea medication that stimulates the pancreas to produce more insulin and helps the body use insulin more effectively.
• The typical starting dose is 1-2 mg once daily with breakfast or the first main meal, with a maximum recommended dose of 8 mg daily.
• Dosage adjustments should be made gradually, usually at 1-2 week intervals, based on blood glucose monitoring results.
• Common side effects include hypoglycemia (low blood sugar), weight gain, and skin reactions.
• Glimepiride should be taken consistently at the same time each day, and patients should monitor their blood sugar regularly while using this medication.

Patient-Specific Factors

• Elderly patients or those with kidney or liver impairment typically require lower doses to reduce the risk of hypoglycemia.
• Patients with type 1 diabetes should not use glimepiride, as it is not effective in this population.
• Patients with a history of hypoglycemia or those taking other medications that increase the risk of hypoglycemia should be closely monitored while taking glimepiride.

Comparison with Other Medications

• Glimepiride has a similar effect on blood glucose lowering as other sulfonylureas, but it has a higher risk of hypoglycemia compared to DPP-4 inhibitors and SGLT-2 inhibitors 1.
• The choice of medication should be individualized based on patient-specific factors, such as kidney function, weight, and risk of hypoglycemia.

Monitoring and Follow-Up

• Patients taking glimepiride should have regular blood glucose monitoring and follow-up appointments with their healthcare provider to adjust the dose as needed and monitor for side effects.
• Patients should also be educated on the signs and symptoms of hypoglycemia and how to manage it.

From the FDA Drug Label

Glimepiride tablets are indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus [see CLINICAL STUDIES (14.1)]. Limitations of Use Glimepiride tablets should not be used for the treatment of type 1 diabetes mellitus or diabetic ketoacidosis, as it would not be effective in these settings. The main use of glimepiride is to improve glycemic control in adults with type 2 diabetes mellitus as an adjunct to diet and exercise 2.

• Indications: type 2 diabetes mellitus
• Limitations of use: not for type 1 diabetes mellitus or diabetic ketoacidosis

From the Research

Overview of Glimepiride

• Glimepiride is a sulphonylurea agent that stimulates insulin release from pancreatic beta-cells and may act via extrapancreatic mechanisms 3.
• It is administered once daily to patients with type 2 diabetes mellitus in whom glycaemia is not controlled by diet and exercise alone 3, 4.
• The effective dosage range of glimepiride is 1 to 8 mg/day, although there is little difference in efficacy between dosages of 4 and 8 mg/day 3, 4.

Efficacy and Safety

• Glimepiride has been shown to be effective in reducing fasting plasma glucose, post-prandial glucose, and glycosylated hemoglobin levels 4, 5.
• It is generally associated with a lower risk of hypoglycemia and less weight gain compared to other sulfonylureas 4, 6.
• Glimepiride can be used in combination with other oral antidiabetic agents or insulin to optimize glycemic control 4, 7, 6.
• The incidence of hypoglycaemia with glimepiride may be lower than with glibenclamide, particularly in the first month of treatment 3.

Comparison with Other Treatments

• Glimepiride was similar in efficacy to glibenclamide and glipizide in 1-year studies 3.
• Glimepiride appears to reduce blood glucose more rapidly than glipizide over the first few weeks of treatment 3.
• Glimepiride plus insulin was as effective as insulin plus placebo in helping patients with secondary sulphonylurea failure to reach a fasting blood glucose target level 3.
• Glimepiride and metformin are effective individually in achieving a glycemic goal with a less daily insulin dose, weight gain, and hypoglycemic episodes in comparison to insulin monotherapy 7.