CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 2, March/April 2014
AFRICA
85
any hypoglycaemic event was 1.8%, rising to 2.0% in those aged
> 65 years. The risk of SUs was greatest for glibenclamide; the
study reported 25% fewer recorded episodes for gliclazide and
40% fewer for glipizide compared with glibenclamide.
29
At the right dose: given the data on dose–response relationships
of the class, it is prudent to use the lowest effective dose of SU,
guided by efficacy parameters such as HbA
1c
levels.
For the right patient: SUs are more likely to cause adverse
effects in patients with risk factors for hypoglycaemia, including
older, frail patients and patients with clinically significant renal
impairment.
30
In addition, any hypoglycaemic effect may be
devastating for specific patients, such as bus drivers. Therefore
SUs should perhaps be avoided in these groups and newer anti-
diabetic drugs considered.
Conclusion
Cost issues remain a barrier between the newer anti-diabetic
drugs and the majority of South African type 2 diabetes patients.
SUs, if used at the right dose (the lowest possible effective
dose), for the right patient (in younger patients without renal
impairment), remain an option for the management of type 2
diabetes patients in resource-constrained settings.
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