Glyburide is an improved
drug for the management of
non-insulin-dependent diabetes mellitus (
NIDDM). It is at least as effective as the first-generation oral
hypoglycemics and is effective in doses that are considerably less than those needed with first-generation sulfonyl-ureas. While its mode of action is similar to that of other agents,
glyburide has the unique feature of prolonged activity despite a short half-life and short duration in the body. Side effects are minimal, and toxic reactions have not been reported. While
hypoglycemic episodes can occur, as with any
blood glucose-lowering agent, they can be prevented by being alert to patients who may be more sensitive to oral agents. Unlike older sulfonylureas, about 50% of
glyburide is excreted through the feces. In 14 years of worldwide experience,
glyburide has rarely shown
disulfiram-like effects and has not shown
antidiuretic effects. While
glyburide produces an
insulin release response to
glucose that parallels a normal physiological response, it appears to also decrease resistance to
insulin and sensitize the receptors while utilizing the patient's available endogenous
insulin. There are two major metabolites, but they are inert and are rapidly excreted, having no
hypoglycemic effect. Considering the safety of
glyburide and the large worldwide population that uses this agent, it is expected that this new second-generation
hypoglycemic agent will greatly increase the therapeutic spectrum for
NIDDM. Not only is it possible for more patients with diabetes to be treated, but many already being treated orally can achieve better regulation with this effective new oral agent.