From the Guidelines
Gliclazide generally does not damage kidneys in diabetic patients and is often considered a safer option for those with kidney issues. According to the most recent evidence from 1, gliclazide is metabolized primarily by the liver, with inactive metabolites excreted through the kidneys, making it suitable for patients with mild to moderate kidney impairment. The standard dosage ranges from 40-320 mg daily, typically starting at a lower dose and adjusting based on blood glucose response.
Key Considerations
- For patients with reduced kidney function, dose adjustment is usually not required until advanced stages of kidney disease (eGFR <30 ml/min) as stated in 1.
- Gliclazide may offer kidney protection through its antioxidant properties and by reducing inflammation and endothelial dysfunction.
- However, all patients taking gliclazide should have regular kidney function monitoring as part of their diabetes management.
- This medication works by stimulating insulin release from pancreatic beta cells and may be used alone or in combination with other diabetes medications, but should be used cautiously in elderly patients or those at risk for hypoglycemia.
Comparison with Other Medications
- As compared to other sulfonylureas, gliclazide has a more favorable profile for patients with kidney issues, as noted in 1.
- Metformin, another common diabetes medication, should not be given to patients with serum creatinine concentrations of 1.5 mg/dL or greater in men and 1.4 mg/dL or greater in women, as it may build up with even modest impairment of kidney function and put patients at risk of lactic acidosis, as mentioned in 1.
Monitoring and Precautions
- Regular monitoring of kidney function is essential for patients taking gliclazide, especially those with pre-existing kidney disease.
- Patients should be cautious of hypoglycemia, particularly when combining gliclazide with other diabetes medications or insulin.
- Elderly patients or those at risk for hypoglycemia should be closely monitored while taking gliclazide.
From the Research
Glicazide and Kidney Damage in Diabetic Patients
- The available evidence suggests that gliclazide may have protective effects on the kidneys of diabetic patients.
- A study published in 2019 found that gliclazide had protective effects on high glucose and advanced glycation end products (AGEs)-induced damage of glomerular mesangial cells and renal tubular epithelial cells via inhibiting RAGE-p22phox-NF-kB pathway 2.
- Another study published in 2015 compared the kidney outcomes of type 2 diabetes patients treated with gliclazide and glimepiride, and found that gliclazide was associated with a lower risk of doubling of creatinine in patients with preserved renal function and good glycaemic control 3.
Mechanism of Action
- Gliclazide stimulates insulin secretion through the beta cell sulphonylurea receptor, and possibly through a direct effect on intracellular calcium transport 4.
- It specifically improves the abnormal first phase insulin release in type 2 diabetes, and also has an effect on the second phase, which may explain the lower incidence of hypoglycaemic episodes and weight gain compared with some other sulphonylureas 4.
Clinical Efficacy and Safety
- Gliclazide in the modified release formulation provides a good 24-h glycemic efficacy comparable to most other groups of glucose lowering drugs, with less frequent hypoglycemic events and no major weight gain 5.
- Cardiovascular outcome studies have shown no evidence of increased cardiovascular events with gliclazide, and the durability of glucose lowering effects is comparable to other drug groups 5.
- A study published in 2012 found that adding pioglitazone to treatment with metformin and gliclazide improved glycemic control in patients with type 2 diabetes 6.