Optimal Utilisation of Sulphonylureas in Resource-Constrained Settings :Review

Sulphonylureas (SUs) are oral anti-diabetic drugs (OADs) that were introduced more than 60 years ago. Clinicians are familiar with their use and they remain extensively used. However; the SU class is associated with adverse effects of weight gain and hypoglycaemia. In addition; their effects on cardiovascular events remain contentious. Newer classes of anti-diabetic agents have been developed and these agents are weight neutral (di-peptidyl peptidase IV inhibitors); while others reduce weight (glucagon-like peptide analogues and sodium glucose co-transporter inhibitors). Furthermore; the newer agents are less likely to cause hypoglycaemia and have a potentially better cardiovascular safety profile. However; the newer agents are more costly than SUs and their long-term safety is unknown. It is therefore likely that SUs will continue to be used; and more so in resource-limited settings. One may mitigate the adverse effects of weight gain and hypoglycaemia associated with the SU class by using members within this class that are less probable to cause these adverse effects. Furthermore; the specific SU must be used at the lowest effective therapeutic dose. In patients at high risk of SU-induced hypoglycaemic episodes (frail; clinically significant renal impairment); or patients in whom hypoglycaemic episodes may have devastating effects (bus drivers); newer anti-diabetic agents may be a justifiable alternative option

The Implementation of Guidelines in a South African Population with Type 2 Diabetes

Objective: The aim of this study was to identify the treatment gaps that pertain to risk factors in South African patients with type 2 diabetes mellitus; using national treatment guidelines.Design: Cross-sectional study.Setting and subjects: The study consisted of 666 patients with type 2 diabetes mellitus; attending a diabetes clinic at the Charlotte Maxeke Johannesburg Academic Hospital.Outcome measures: Using a public sector database; retrospective data were obtained on the treatment of type 2 diabetes mellitus participants. Patients were randomly selected on the basis of established type 2 diabetes mellitus diagnosis; and if they were receiving oral hypoglycaemic and/or insulin therapy. Age; gender; race; blood pressure; haemoglobin A1c (HbA1c) and fasting lipids were captured and measured. The history of patients' previous coronary artery disease; strokes; nephropathy; neuropathy and retinopathy was recorded.Results: The mean age of the patients was 63 years [standard deviation (SD) 11.9]; 55of whom were females. The HbA1c was 8.8 (SD 2.5). 26.2 of patients attained HbA1c levels of 7. Of the total patients; 45.8 met a 130/80 mmHg blood pressure target; and 53.8 a low-density lipoprotein (LDL) cholesterol of 2.5 mmol/l. Only 7.5 obtained the combined target for HbA1c ; blood pressure and LDL cholesterol.Conclusion: Traditionally; type 2 diabetes mellitus treatment has centred on correcting blood glucose levels. Yet; as many as 80