Sulfonylureas are a class of medicines that have been used to treat type 2 diabetes since the 1950s. They work by stimulating beta cells in the pancreas to release more insulin. In addition, they may prevent the liver from releasing stored glucose into the bloodstream. Both actions can result in lower blood glucose levels. According to the Agency for Healthcare Research and Quality, sulfonylureas are associated with a one point decrease in A1c levels.
Who should use a sulfonylurea
With their long track record as safe and effective medications, sulfonylureas are often prescribed as a first-line treatment for type 2 diabetes patients. Generally, they are intended for use when diet and exercise alone cannot keep blood glucose levels within a target range. In addition, sulfonylureas are only effective when there is some beta-cell activity present in the pancreas which means they are not suitable for those with type 1 diabetes.
Although considered safe for most individuals, sulfonylureas are not recommended for pregnant women or those with liver or kidney problems. In addition, patients using these medications for several years may find they become less effective over time.
Medications in the sulfonylurea class
Originally, there were four first generation sulfonylureas. Acetohexamide was sold under the brand name Dymelor while tolbutamide was available under the brand names Orinase and Tol-Tab. Tolazamide was sold as Tolinase. However, the American Diabetes Association reports only one first generation sulfonylurea is currently available for prescription: chlorpropamide which goes by the brand name Diabinese.
There are also three second generation drugs available. They go by the following generic and brand names:
- Glipizide (Glucotrol and Glucotrol XL)
- Glimepiride (Amaryl)
- Glyburide (Micronase, DiaBeta, Glynase PresTab, Glycron)
Other sulfonylureas are available as combination drugs that are mixed with other type 2 diabetes medications and may offer additional benefits such as lower cholesterol levels. There are several brand name combination drugs on the market:
- Duetact (glimepiride and pioglitazone)
- Metaglip (glipizide and metformin)
- Glucovance (glyburide and metformin)
Common side effects and dosages
There are both first and second generation sulfonylureas available on the market today. Second generation drugs may require smaller dosages but with either generation of medications, patients may take pills once or twice a day before meals. Sulfonylureas are typically well tolerated by most patients, but some individuals may encounter side effects. According to the AHRQ, these medications can lead to low blood glucose, weight gain or stomach problems.
Be sure to consult with your physician regarding any medication use, issues or questions.
American Diabetes Association, "What Are My Options?"
University of Illinois, "Type 2 Diabetes Medications: Sulfonylureas"