Cost-effective management of hyperglycemia in patients with type 2 diabetes using oral agents

Diabetes exacts an enormous toll on health care resources, with extremely high costs attributable to care of diabetes patients in proportion to the afflicted population. Though individual treatment strategies are required for each patient, newer long-acting sulfonylureas may be the initial drugs of choice, as they may be the only oral agents that inhibit the processes inducing hyperglycemia--hepatic glucose production and glucose utilization by the tissues--by improving insulin secretion and insulin resistance. Sulfonylureas also represent the most cost-effective therapeutic option, alone or in combination with other oral agents or insulin. The newer long-acting agents, glimepiride and glipizide GITS, may be more attractive among sulfonylureas, due to their greater insulin-sparing property, fewer hypoglycemic events, weight neutrality, and once-daily dosing. Glimepiride may be preferred due to its safety profile, especially for the elderly and those with hepatic and/or renal dysfunction.