THE EFFECT ON METABOLIC CONTROL OF 2ND-GENERATION SULFONYLUREA DRUGS IN PATIENTS WITH NIDDM AFTER SECONDARY FAILURE TO FIRST-GENERATION AGENTS

BACKGROUND. The literature contains few data examining the results of therapy with second-generation sulfonylurea drugs in subjects with non -insulin-dependent diabetes mellitus (NIDDM) after the onset of second ary failure to first-generation agents. The present study was undertak en to assess the efficacy of therapy with second-generation sulfonylur ea in subjects with NIDDM following secondary failure to first-generat ion agents. METHODS. The study included 55 subjects with NIDDM who man ifested secondary failure to first-generation sulfonylurea therapy. Of these, 29 subjects underwent therapy with the second-generation sulfo nylurea glipizide, and 26 subjects were treated with glyburide, both d rugs administered in the maximum daily dosage. Before initiation of th e second-generation sulfonylurea agents and again at the end of 6 mont hs, metabolic control was assessed by determination of fasting plasma glucose, glycosylated hemoglobin (HbA(1c)), and the lipid profile, RES ULTS. Fasting plasma glucose and HbA(1c) levels were 209+/-31 mg/dL an d 12.3+/-2.1%, respectively, before initiation of glipizide, and did n ot significantly change following therapy (fasting plasma glucose, 211 +/-34 mg/dL; HbA(1c), 11.7+/-1.8%). Similarly, no significant alterati on was noted in these metabolic values in the glyburide group (before glyburide therapy, fasting plasma glucose, 180+/-16 mg/dL; HbA(1c), 11 .2+/-1.6%; after glyburide therapy, fasting plasma glucose, 184+/-20 m g/dL; HbA(1c), 11.0+/-1.5%). Lipids also were not significantly altere d following therapy with either glipizide or glyburide. Finally, for a ll subjects, fasting plasma glucose and HbA(1c) were 200+/-27 mg/dL an d 11.9+/-2.0%, respectively, during treatment with first-generation dr ugs and did not change significantly following therapy with the second -generation agents (fasting plasma glucose, 205+/-20 mg/dL; HbA(1c), 1 1.2+/-1.2%], P values were >.60 for all comparisons, CONCLUSIONS. Trea tment with second-generation sulfonylurea agents for patients with NID DM following onset of secondary failure to first-generation sulfonylur ea drugs achieves no better metabolic control than treatment : with fi rst-generation agents.