How do the second-generation sulfonylureas differ with regard to their blood sugar-lowering effects? I read that glimepiride is the safest of these antihypoglycemic agents, but there was no explanation as to why this is the case.
—Suzannne R. Martini, FNP-C, Howell, Mich.

The second-generation sulfonylureas are all equally effective at lowering blood sugar. Each sulfonylurea forms active metabolites that result in prolonged time of action. All can be given once a day and carry a risk of hypoglycemia. Glimepiride is also more selective for pancreatic sulfonylurea receptors over cardiac receptors, but the clinical significance of this difference is not yet established. For more information, see CMAJ. 2006;174:185-186.
—Julee B. Waldrop, MS, PNP (101-13)

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