Oral hypoglycaemic agents: the first thirty years.

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.
• 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.