In patients with type 2 diabetes mellitus (T2DM) who require additional glucose-lowering on top of first-line metformin monotherapy, sulfonylureas are the most common choice for second-line therapy followed by dipeptidyl peptidase inhibitors (DPP-4i). This article summarises presentations at a symposium entitled “Real-World Evidence and New Perspectives with Gliclazide MR” held at the International Diabetes Federation Congress in Busan, South Korea on 4 December 2019. Although guideline recommendations vary between countries, the guidelines with the highest quality ratings include sulfonylureas as one of the preferred choices as second-line therapy for T2DM. Data from randomised controlled trials (RCTs) have consistently demonstrated that sulfonylureas are effective glucose-lowering agents and that the risk of severe hypoglycaemia with these agents is low. In addition, both RCTs and real-world observational studies have shown no increased risk of mortality or cardiovascular disease with the use of newer-generation sulfonylureas compared with other classes of glucose-lowering treatments. However, differences between sulfonylureas do exist, with gliclazide being associated with a significantly lower risk of mortality or cardiovascular mortality compared with glibenclamide, as well as the lowest incidence of severe hypoglycaemia compared with other agents in this class. Recent real-world studies into the effectiveness and safety of gliclazide appear to confirm these findings, and publication of new data from these studies in patients with T2DM in the UK, and in Muslim patients who are fasting during Ramadan, are awaited with interest. Another study being undertaken with gliclazide is a pan-India study in patients with maturity-onset diabetes of the young (MODY) subtypes 1, 3 and 12. Patients with these MODY subtypes respond particularly well to sulfonylurea treatment, and sulfonylureas are the first-line agents of choice in these patients. These new and ongoing studies will add to the cumulative data on the efficacy and safety of certain sulfonylureas in patients with diabetes.

中文翻译：

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格列齐特MR在2型糖尿病管理中的作用：关于真实证据和新观点的研讨会报告。

对于一线二甲双胍单药治疗需要额外降低血糖的2型糖尿病（T2DM）患者，磺酰脲类药物是二线治疗和二肽基肽酶抑制剂（DPP-4i）的最常见选择。本文总结了在2019年12月4日在韩国釜山举行的国际糖尿病联盟大会上举行的题为“使用格列齐特MR的现实证据和新观点”的专题讨论会上的演讲。尽管指南建议因国家而异，但指南的质量最高评级包括磺脲类药物作为T2DM二线治疗的首选之一。随机对照试验（RCT）的数据一致表明，磺酰脲类是有效的降糖药，使用这些药物引起严重低血糖的风险低。此外，RCT和现实世界的观察性研究均表明，与其他类别的降糖治疗相比，使用新一代磺酰脲不会增加死亡率或心血管疾病的风险。但是，磺酰脲类之间确实存在差异，与格列本脲相比，格列齐特与死亡率或心血管疾病死亡率显着降低相关，并且与此类其他药物相比，严重低血糖发生率最低。最近在现实世界中对格列齐特的有效性和安全性进行的研究似乎证实了这些发现，并有兴趣地等待着来自英国的T2DM患者以及斋月期间禁食的穆斯林患者的这些研究的新数据的发布。格列齐特正在进行的另一项研究是一项针对印度（1、2、3和12型年轻（MODY）成熟型糖尿病患者）的泛印度研究。在这些患者中首选线型药物。这些新的和正在进行的研究将增加某些磺酰脲类药物在糖尿病患者中的有效性和安全性的累积数据。格列齐特正在进行的另一项研究是一项针对印度（1、2、3和12型年轻（MODY）成熟型糖尿病患者）的泛印度研究。在这些患者中首选线型药物。这些新的和正在进行的研究将增加某些磺酰脲类药物在糖尿病患者中的有效性和安全性的累积数据。格列齐特正在进行的另一项研究是一项针对印度（1、2、3和12型年轻（MODY）成熟型糖尿病患者）的泛印度研究，这些MODY亚型的患者对磺脲类药物的治疗反应特别好，而磺脲类药物是第一个在这些患者中首选线型药物。这些新的和正在进行的研究将增加某些磺酰脲类药物在糖尿病患者中的有效性和安全性的累积数据。