Cost-effective Management of Hyperglycemia in Patients With Type 2 Diabetes Using Oral Agents

Sulfonylureas are cost-effective and also may be the only oral agents that inhibit processes inducing hyperglycemia by improving insulin secretion and insulin resistance. New long-acting agents hold even greater promise.

Udaya M. Kabadi, MD
University of Iowa Hospitals and Clinics


Diabetes exacts an enormous toll on health care resources, with extremely high costs attributable to care of diabetes patients in proportion to the afflicted population. Though individual treatment strategies are required for each patient, newer long-acting sulfonylureas may be the initial drugs of choice, as they may be the only oral agents that inhibit the processes inducing hyperglycemia — hepatic glucose production and glucose utilization by the tissues — by improving insulin secretion and insulin resistance. Sulfonylureas also represent the most cost-effective therapeutic option, alone or in combination with other oral agents or insulin. The newer long-acting agents, glimepiride and glipizide GITS, may be more attractive among sulfonylureas, due to their greater insulin-sparing property, fewer hypoglycemic events, weight neutrality, and once-daily dosing. Glimepiride may be preferred due to its safety profile, especially for the elderly and those with hepatic and /or renal dysfunction.

Author correspondence:
Udaya M. Kabadi, MD
Professor of Medicine
Division of Endocrinology
University of Iowa Hospitals and Clinics
601 US Highway 6
Iowa City, IA 52246-2208

This paper has undergone peer review by appropriate members of Managed Care's Editorial Advisory Board.

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