From the Guidelines
Glipizide should be used with caution in patients with type 2 diabetes, particularly in those with kidney or liver problems, due to the risk of hypoglycemia, and the dose should be initiated conservatively to avoid hypoglycemia, as recommended by the most recent guidelines 1.
Key Considerations
- Glipizide is a sulfonylurea that stimulates the pancreas to produce more insulin and helps the body use insulin more effectively.
- The typical starting dose is 5 mg once daily before breakfast, which may be adjusted based on blood glucose response, up to a maximum of 40 mg daily.
- Common side effects include hypoglycemia, weight gain, nausea, and skin reactions.
- Hypoglycemia is the most serious risk, especially in elderly patients or those with kidney or liver problems.
Patient Monitoring and Precautions
- Patients should monitor their blood sugar regularly and maintain consistent meal timing to minimize the risk of hypoglycemia.
- Alcohol consumption should be avoided, and patients should be aware of hypoglycemia symptoms such as shakiness, sweating, and confusion.
- Glipizide is not appropriate for type 1 diabetes, diabetic ketoacidosis, or during pregnancy.
Mechanism of Action and Efficacy
- Glipizide works by binding to ATP-sensitive potassium channels on pancreatic beta cells, causing membrane depolarization and increased insulin secretion.
- It is effective for patients with some remaining pancreatic function, as it stimulates the pancreas to produce more insulin.
Special Considerations in CKD
- Patients with decreased kidney function (CKD stages 3 to 5) have increased risks for hypoglycemia due to decreased clearance of insulin and some oral agents, and impaired kidney gluconeogenesis 1.
- Glipizide is preferred over other sulfonylureas in patients with CKD because it does not have active metabolites and does not increase the risk of hypoglycemia.
From the FDA Drug Label
INDICATIONS AND USAGE Glipizide tablets are indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. The FDA drug label does not answer the question.
From the Research
Glipizide Overview
- Glipizide is a sulfonylurea used in the treatment of type 2 diabetes mellitus 2, 3, 4, 5
- It works by stimulating the release of insulin from the pancreas, helping to lower blood glucose levels
Efficacy and Safety
- Studies have shown that glipizide can improve glucose control in patients with type 2 diabetes, with significant reductions in fasting plasma glucose and glycated hemoglobin levels 2
- However, glipizide has also been associated with weight gain and hypoglycemia, particularly when compared to other treatments such as dapagliflozin 4, 5
- Dapagliflozin has been shown to produce significant adjusted mean weight loss and decrease the proportion of patients experiencing hypoglycemia compared to glipizide 4, 5
Combination Therapy
- Glipizide can be used in combination with other treatments, such as metformin and insulin, to achieve better glucose control 2, 3, 4, 5
- The addition of glipizide to insulin therapy has been shown to result in a rapid and substantial improvement in glucose control, despite a significant reduction in insulin dose 2
- Combination therapy with glipizide and other agents, such as DPP-4 inhibitors and SGLT-2 inhibitors, can also be effective in achieving glucose control 6
Comparison to Other Treatments
- Glipizide has been compared to other treatments, such as dapagliflozin, in terms of efficacy and safety 4, 5
- Dapagliflozin has been shown to have similar glycemic efficacy to glipizide, but with a more favorable safety profile in terms of weight loss and hypoglycemia 4, 5
- Other treatments, such as GLP-1 receptor agonists and insulin analogs, may also be effective alternatives to glipizide in certain patients 6