Patients with type 2 diabetes often take medication to help the body increase insulin production. These drugs fall into two classes: sulfonylureas and glinides (also called meglitinides).
Sulfonylureas have been around for a number of years, and the glinides are a newer addition to the pharmacy. If your physician prescribes a drug from one of these classes, it means that the beta cells in your pancreas are still able to store and release some insulin. These medications are referred to as insulin secretagogues. This means they help your pancreas produce higher levels of insulin.
How It Works
Most sulfonylureas administered today are second generation drugs such as glyburide, glipizide, and glimepiride. Some of the brand names of glyburide include Micronase, DiaBeta, and Glynase PreStab. Glucotrol is a brand name for glipizide, and Amaryl is a brand name for glimepiride.
Sulfonylureas mainly work by enhancing the glucose sensitivity of the beta cells in the pancreas. This means that when your blood glucose levels increase — usually after your meal — then the amount of insulin released increases in response (as it would if your pancreas were functioning normally). Some sulfonylureas are long acting and need to be taken only once a day; others must be taken more frequently.
The glinides include repaglinide and nateglinide, and the brand names are Starlix and Prandin, respectively. These drugs are fast acting; they affect your body more rapidly than sulfonylureas do. However, they do not last long. You have to take glinides before or at every meal as they work by enhancing your early post-meal insulin production.
Physicians often prescribe a sulfonylurea or glinide with another antidiabetic drug (such as Metformin) to help control your type 2 diabetes, particularly if your condition has not responded to diet and lifestyle modifications. These complementary drugs work in ways other than increasing insulin production.
Are There Any Risks?
Most people with type 2 diabetes can tolerate these types of drugs well. However, like any medication, they can cause unwanted side effects such as nausea or constipation when you first start to take them. If side effects become a problem, discuss them with your physician.
Patients taking sulfonylureas will likely have a higher risk of hypoglycemia, and some sulfonylurea medications carry a higher risk than others. The glinides do have some risk of causing hypoglycemic events; however, this risk is considerably less than the sulfonylureas.
Across both drug groups there are also risks of significant weight gain. You should work with your physician to carefully consider the benefits of these drugs against the risks.
If your beta cells deteriorate further and become unable to produce insulin, then sulfonylureas and glinides will no longer be suitable treatment.
Other Disorders Sulfonylureas and Glinides Treat
Sulfonylureas and glinides are exclusively for diabetics who still have some functioning beta cells. At this time, these drugs are not used to treat any other condition.
What the Experts Say
Lifestyle modification is still important in the management of type 2 diabetes. In practice, medications are almost always prescribed alongside diet and exercise recommendations. It is important that physicians consider advantages and disadvantages of each type of treatment to choose a regimen that meets the goals of the individual.
It can be difficult to compare the effectiveness of sulfonylureas, glinides, and other antidiabetic medications, as they tend to reach peak effects at different times.
The Institute for Clinical Systems Improvement reports that the “single best choice drug for oral agent therapy for type 2 diabetes has not been determined,” and the American Diabetes Association also recommends a number of treatment combinations for diabetics.
For more information on antidiabetic drugs: