Review Article

Dose-Response Relationships of Sulfonylureas: Will Doubling the Dose Double the Response?

Authors: Virendra Rambiritch, PhD, Poobalan Naidoo, BPharm, MMedSc, Neil Butkow, PhD

Abstract

type 2 diabetes mellitus is currently a global health problem. Although the armamentarium of oral hypoglycemic agents is continuously expanding, sulfonylureas (SUs) are still extensively used for the management of type 2 diabetes mellitus. However, despite decades of use, there is controversy as to the dosing of SUs. Despite many dose-response relationship studies indicating that SUs should be prescribed at lower doses, their dose recommendations remain unchanged. Moreover, studies have demonstrated that high doses of SUs may result in a deterioration of glycemic control and increased frequency of protracted hypoglycemic episodes. In view of the controversial dose-response relationship of SUs, it is suggested that the dose of SUs be titrated against glycemic parameters of blood glucose and glycated hemoglobin.


Key Points


* There is much controversy regarding the dosing of sulfonylureas (SUs).


* There is considerable evidence suggesting that SUs have maximal blood glucose-lowering effects at doses lower than the manufacturer’s maximum recommended dose.


* High-dose SUs may impair glycemic control and are associated with an increased risk of hypoglycemic episodes.

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