ABSTRACT
Four pharmacological classes of oral agents are
currently used for treating type 2 diabetes:
sulphonylureas (or more recently new insulin
secretagogues of the meglitinide family),
biguanides (metformin), -glucosidase
inhibitors (acarbose and miglitol) and
thiazolidinediones, also called glitazones
(troglitazone which has been recently
withdrawn because of hepatotoxicity,
rosiglitazone and pioglitazone)104,105 (Figure
2.7). If the oral treatment fails, insulin therapy
may be prescribed, alone or in combination
with oral agents. The selection of an oral anti-
diabetic compound depends on several factors,
including the severity of hyperglycaemia and
some characteristics of the patient, especially
the presence of obesity.11,106
The oral administration of drugs which aim at
stimulating insulin release (in clinical practice,
sulphonylureas or in some countries,
meglitinide analogues such as repaglinide or
nateglinide) is a cornerstone in the treatment
of type 2 diabetes.107,108 However, such an
approach may be less relevant in the obese
diabetic patient.10 Those who oppose the use
of sulphonylureas often argue that
sulphonylurea treatment could be
counterproductive because it may lead to
weight gain, hyperinsulinaemia and even more
severe insulin resistance, all effects which are
particularly unwanted in obese subjects. It is
essential that this series of events be kept in
mind whenever sulphonylurea therapy is
started and that every effort is made to
prevent it. In the United Kingdom
Prospective Diabetes Study (UKPDS),
sulphonylurea therapy with either
chlorpropamide or glibenclamide in
overweight patients with newly diagnosed
type 2 diabetes that could not be controlled
with diet therapy resulted in an average 3.7 kg
weight gain after 6 years.109
