Evaluating gliclazide for the treatment of type 2 diabetes mellitus

Introduction: Sulfonylureas have been the standard second-line treatment after failure of metformin monotherapy in patients with type 2 diabetes (T2D) but they are becoming less popular as the newer glucose-lowering agents have a relatively lower risk of hypoglycemia and some of them have been shown to reduce cardiovascular and renal events. Gliclazide differs from other sulfonylureas in several respects and may provide a suitable option for some patients with T2D. Areas covered: In this article, we review the pharmacokinetics, pharmacodynamics and clinical efficacy of gliclazide based on the available literature. Expert opinion: Gliclazide in the modified release (MR) formulation given once daily provides a good 24-h glycemic efficacy comparable to most other groups of glucose lowering drugs. Hypoglycemic events are less frequent than with some other sulfonylureas, and weight gain is not a major problem. Cardiovascular outcome studies have shown no evidence of increased cardiovascular events with gliclazide, and the durability of glucose lowering effects is comparable to other drug groups. Lower doses of gliclazide appear to have an incretin-enhancing effect, and overall it can provide a cost-effective treatment that is useful in many patients.