Interactive diabetes case 17: A 47-year-old patient with newly discovered type 2 diabetes – A3

ANSWER — Incorrect.

Sulfonylureas are effective agents for the treatment of newly diagnosed type 2 diabetes but are not indicated as initial pharmacologic therapy. (See "Initial management of hyperglycemia in adults with type 2 diabetes mellitus".)

Sulfonylureas reduce the glycated hemoglobin (A1C) to an extent comparable with metformin, approximately 1.5 percent, but are associated with a weight gain of approximately 2 kg. Sulfonylureas carry the risk of hypoglycemia, especially the longer-lasting agents in older adults, although episodes of severe hypoglycemia (requiring the help of someone else) are infrequent. Among second-generation sulfonylureas (the preferred group of agents), glyburide is more likely to cause hypoglycemia than glipizide or glimepiride and is not the preferred agent in this class. Glyburide should not be used in patients with renal insufficiency (a serum creatinine >1.5 mg/dL in men or >1.4 mg/dL in women) because of the increased risk of hypoglycemia. Glipizide is preferred in this setting. (See "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus".)

In a patient with a contraindication to metformin because of preexistent gastrointestinal disease, or in a patient who does not tolerate a careful trial of metformin, a sulfonylurea such as glipizide is a reasonable alternative. While sulfonylureas are not the first choice for pharmacologic therapy of newly diagnosed diabetes, an agent in this class may have a role as an additional medication in patients who are not well controlled with one drug, usually metformin. (See "Management of persistent hyperglycemia in type 2 diabetes mellitus".)

Return to the beginning to try again. (See "Interactive diabetes case 17: A 47-year-old patient with newly discovered type 2 diabetes".)