What is an example of a rapid-acting sulfonylurea (oral hypoglycemic agent)?

From the Guidelines

Rapid-acting sulfonylureas are not the preferred initial treatment for type 2 diabetes due to their higher risk of hypoglycemia, but they can be considered as an alternative to metformin in certain situations, such as when metformin is contraindicated or not tolerated, as stated in the 2016 American Diabetes Association standards of medical care in diabetes 1.

Key Considerations

• Rapid-acting sulfonylureas, such as glyburide, glipizide, and glimepiride, stimulate pancreatic beta cells to release insulin, making them effective for immediate glucose control.
• These medications should be taken before meals to maximize effectiveness and minimize hypoglycemia risk.
• Patients should be aware that rapid-acting sulfonylureas carry a higher risk of hypoglycemia compared to other diabetes medications, especially in elderly patients or those with kidney impairment.
• The 2009 consensus algorithm for the initiation and adjustment of therapy for type 2 diabetes recommends metformin as the initial pharmacological therapy, with sulfonylureas considered as a second-tier option 1.

Treatment Guidelines

• Typical dosing for glipizide starts at 5mg daily before breakfast, potentially increasing to 10-20mg daily if needed.
• Glyburide usually begins at 2.5-5mg daily, while glimepiride starts at 1-2mg once daily.
• Regular blood glucose monitoring is essential when using these medications to prevent dangerous drops in blood sugar levels.
• The choice of oral agents should be individualized, taking into account the patient's specific needs and medical history, as recommended in the 2005 guidelines for management of diabetes during Ramadan 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Rapid Acting Sulfonylureas

• Rapid acting sulfonylureas are a class of medications used to treat type 2 diabetes mellitus 2, 3, 4.
• They work by stimulating the release of insulin from the pancreas, which helps to lower blood glucose levels 3, 4.
• Examples of rapid acting sulfonylureas include glipizide and glimepiride 2, 3.

Characteristics of Rapid Acting Sulfonylureas

• Glipizide has rapid and complete absorption, as well as a rapid distribution and elimination 3.
• Glimepiride is associated with a reduced likelihood of hypoglycemia and a smaller increase in fasting insulin and C-peptide levels compared to glyburide 2.
• Rapid acting sulfonylureas may be more effective in reducing postprandial hyperglycemia due to their ability to improve first-phase insulin secretion 2, 4.

Clinical Use of Rapid Acting Sulfonylureas

• Rapid acting sulfonylureas can be used as monotherapy or in combination with other medications to treat type 2 diabetes mellitus 5, 6.
• They may be particularly useful in patients who require a rapid reduction in blood glucose levels, such as those with insulin-requiring type 2 diabetes mellitus 6.
• The dose of rapid acting sulfonylureas should be individualized and monitored regularly to minimize the risk of hypoglycemia and other adverse effects 5.