# \[e-drug\] Antidiabetic drugs (cont) **URL:** \ **Category:** e-drug\ **Created:** [September 23, 2002, 10:26pm UTC](https://talk.edrugplus.org/t/e-drug-antidiabetic-drugs-cont/14976 "2002-09-23T22:26:37Z")\ **Posts on this page:** 1\ **Page:** 1
**Author:** ![Perla\_Mordujovich1](https://avatars.discourse-cdn.com/v4/letter/p/73ab20/32.png) [@Perla\_Mordujovich1](https://talk.edrugplus.org/u/Perla_Mordujovich1)\ **Post date:** [September 23, 2002, 10:26pm UTC](https://talk.edrugplus.org/t/e-drug-antidiabetic-drugs-cont/14976/1 "2002-09-23T22:26:37Z")
E-drug: Antidiabetic drugs (cont) --------------------------------------------- Dear Valeria and Leo Offerhaus: I'd like to make some commentaries related with hypoglycaemic drugs.. 1) Valeria's suggestions about 3 hypoglycaemic drugs on the current       WHO EDL. 2) Leo Offerhaus' commentary about front boxes in the EDL. 1) I have participated in some of the WHO Essential Committees and I can      exchange with both of you my opinion:     1.1-Insulin 40U/100U This issue has been discussed in several meetings and the reason for keeping the 40U is that in several nondeveloping countries is the only one they have. Any way, it was highlighted the intention of some of these countries representatives to promote changes in their own countries. There is a general agreement about the need of its deletion from the EDL.     1.2- Glibenclamide If we look at the evidences of efficacy of glucose lowering drugs , not only to normalize glyceaemia but, more important, to prevent or delay diabetic complications, the only sulfonylurea which has already demonstrated efficacy to prevent or delay microangiopathic complications is glibenclamide. In the UKPDS trial only "strict control" by glibenclamide had a significantly favourable effect on the incidence of the "first clinical complication of diabetes". Insulin and chlorpropamide had no such effect.. The UKPDS trial followed for 10 years more than 4200 diabetics. (They had only 2% lost to follow-up). It has been argued that this trial had many methodological strengths : independent team, largely public funding, a protocol published in advance, relevant end points, and is pragmatic (the study population and the treatments corresponded to routine clinical practice). But also has some flaws: it was unblinded, few patients stayed on the initially allocated single-drug-glucose lowering regimen throughout the trial. But UKPDS is the best published trial to assess the benefit of therapies for patients under 65 with recent onset type 2 diabetes (patients who failed to be controlled only with non pharmacological treatment) We don't have yet trial's results like these with gliclazide. Up to that time, we should choose glibenclamide for the treatment of non overweighted type 2 diabetes patients. In terms of safety, hypoglycaemia could be avoided selecting the exact dosage each patient need , taking into account adequate diets and programme of physical activities. In terms of cost , glibenclamide is the cheapest one. An analysis of the comparative mean cost of treatments/month with oral hypoglycaemic drugs made for us last year in Argentina showed these value for both drugs: glibenclamide 13,50 US$/month gliclazide 26,40 US$/month So , if we take into account the best available evidence of the Benefit/risk/cost analysis for the treatment of non obese type 2 diabetes patients, we must choose glibenclamide. Considering its convenience, we remember the possibility of hypoglycaemia , so we have to add the precautions needed in choosing its dosage. References 1-UKPDS . Group " Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes" UKPDS 33 Lancet 1998;352:854-865. 2-Management of type 2 diabetes Rev. Prescrire; 1999;19(196):448-456. 2). In relation to the square box in front of glibenclamide in the EDL , we must add that there is an ongoing discussion in the WHO EDL Committees, on the issue of square boxes. Not all drugs can be replaced by others of the same group.   A paradigmatic example on this issue are NSAIDS. If we keep a square box in front of ibuprofen., we could choose naproxen or diclofenac instead (they belong also to the NSAIDS group) but, all three medicines expose patients to different risks of GI adverse effects. We can conclude that they are not exchangeable in terms of their GI safety. With best regards Dr Perla M Buschiazzo Professor of Pharmacology School of Medicine National University of La Plata Argentina "Perla Mordujovich" \ -- To send a message to E-Drug, write to: e-drug@usa.healthnet.org To subscribe or unsubscribe, write to: majordomo@usa.healthnet.org in the body of the message type: subscribe e-drug OR unsubscribe e-drug To contact a person, send a message to: e-drug-help@usa.healthnet.org Information and archives: [http://www.healthnet.org/programs/edrug.html](http://www.healthnet.org/programs/edrug.html)