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Oral hypoglycaemic agents: the first thirty years.

¹Middlesex Hospital, London.

Journal of the Royal College of Physicians of London

|January 1, 1992

Summary

Oral hypoglycaemic agents (OHAs) were used in over 1,300 patients with non-insulin dependent diabetes (NIDDM). While many achieved control, some developed complications or required insulin, with a 5% annual secondary failure rate.

Area of Science:

Endocrinology
Metabolic Diseases
Pharmacology

Background:

Non-insulin dependent diabetes mellitus (NIDDM) management has evolved significantly.
Oral hypoglycaemic agents (OHAs) have been a cornerstone in NIDDM treatment for decades.
Understanding long-term outcomes of OHA use is crucial for patient care.

Purpose of the Study:

To describe the long-term outcomes of oral hypoglycaemic agent (OHA) treatment in a large cohort of patients with non-insulin dependent diabetes (NIDDM).
To evaluate the efficacy, secondary failure rates, and complications associated with OHA therapy.
To assess the use of OHAs in insulin dependent diabetes (IDDM) in early disease stages.

Main Methods:

Retrospective analysis of 1,333 NIDDM patients treated with OHAs between 1956 and 1988.

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Inclusion of 137 insulin dependent diabetes (IDDM) patients treated with OHAs.

Follow-up data collection over a 32-year period to assess control, complications, and treatment changes.

Main Results:

51% of NIDDM patients on OHAs achieved satisfactory control; 262 died, 223 switched to insulin, and 41 stopped OHAs.
Annual secondary failure rate was approximately 5% between years 1 and 20.
NIDDM patients on OHAs showed higher rates of neuropathy, peripheral vascular disease, and coronary artery disease compared to insulin-treated patients.
44% of IDDM patients treated with OHAs achieved good control for at least 12 months.

Conclusions:

Long-term OHA use in NIDDM is associated with significant secondary failure rates and increased risk of microvascular and macrovascular complications.
While OHAs can be effective in early IDDM, long-term efficacy and safety require careful monitoring.
Side effects of OHAs were generally mild, with hypoglycemia, rashes, and gastrointestinal symptoms being infrequent.