Use of Sulfonylurea Based on Diet Recall

Sulfonylureas are the most potent oral diabetes agents in terms of possibility of hypoglycemia. As per our institutional diabetes management protocol, we offer sulfonylurea group of drugs in patients with type 2 diabetes not able to achieve glycemic goal with maximum tolerated dose of two non-sulfonylurea group of oral anti diabetes agents for 3 months. We propose to use of sulfonylurea group of drugs precisely based on patients diet, particularly meal pattern and carbohydrate percentage in each meal to reduce the episodes of hypoglycemia.

Methods:

There were total 593 patients whom we have offered sulfonylurea group of drugs as per protocol from July 2021 to December 2021. Out of which 286 patients whose SMBG data was available as per eighty percent or more of advised frequency were analysed further. All patients were divided into three groups. Group A with three major meals per day consists of 228 patients, group B with two major meals per day consists of 42 patients and group C with one major meal per day consists of 16 patients. Group A was offered glipizide 5mg if carbohydrate (CHO) percentage in meal was < 55% or gliclazide - immediate release if CHO percentage was > 55% (40 mg if HbA1c 7-8% and 80mg if HbA1c 8-9%), Group B was offered modified release or extended release gliclazide 30mg if CHO percentage in meal was < 55% or modified release or extended release gliclazide 60mg if CHO percentage was > 55% and Group C was offered glimipiride 1mg if CHO percentage in meal was < 55% and glimipiride 2mg if > 55%. All these patients were explained to do SMBG daily once at different time, minimum 5 days a week and to report in a sheet provided by institute or update digitally in an application. Patients with SMBG value < 70 mg/dl more than one tine in a month were offered ambulatory glucose profile (AGP) with Abott free style Libre Pro. Results were analysed at 3 months and 6 months in terms of achieving glycemic target, no. of hypoglycemia events (RBS < 70 mg/dl) and need of AGP and time in range > 70% with time below range < 5%.

Results:

Out of 286 patients 221 (77.27%) patients achieved target HbA1c at 3 month and 254 (88.81%) patients achieved target HbA1c at six months. Only 21 patients reported hypoglycemia more than one time in a month and on AGP 19 patients out of 21 with reported hypoglycemia were having TIR (Time In Range) > 70 % and only 2 patient were showing TBR (Time Below Range) > 4%.