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Aim The primary objective of this document is to develop practice-based expert group opinion on certain important but less discussed endocrine and metabolic effects of modern sulfonylureas (SUs) and their usage in the management of diabetes mellitus (DM). Background Modern SUs may be considered a panacea in DM care with their beneficial extra-pancreatic, pleiotropic, and cardiovascular effects. Safe glycemic control with SUs could be achieved with appropriate patient selection, drug and dosage selection, and patient empowerment. Additionally, sulfonylureas also exhibit certain endocrine and metabolic effects, which could be considered beneficial in the management of DM. In this regard, a group of international clinical experts discussed the less known beneficial aspects of SUs and safe and smart prescription of modern SUs in DM care. Results The concept of glucocrinology or the relationship of glycemia with the endocrine system was emphasized during the meetings. Clinical experts arrived at a consensus for the usage of modern SUs in the presence of other endocrine dysfunction and the impact of these drugs on endocrine health. The beneficial pleiotropic and cardiovascular effects of modern SUs were also discussed. The key discussion points were considered to develop clinical expert opinions for the use of modern SUs in persons with DM. Clinical expert opinions were developed for indications, pleiotropic benefits, cardiovascular outcomes, adherence, and safe use of modern SUs. Conclusions Appropriate clinical judgement coupled with a patient-centered approach is crucial to achieve the best outcome in persons with DM. Owing to their safety, efficacy, extra-pancreatic benefits including effects on endocrine and metabolic aspects, and low cost of therapy, modern SUs could be considered as drugs/agents of choice for the treatment of diabetes. Funding Sanofi India. Electronic Supplementary Material The online version of this article (10.1007/s13300-019-0651-1) contains supplementary material, which is available to authorized users.

Aim The primary objective of this review is to develop practice-based expert group opinions on the cardiovascular (CV) safety and utility of modern sulfonylureas (SUs) in cardiovascular outcome trials (CVOTs). Background The United States Food and Drug Administration issued new guidance to the pharmaceutical industry in 2008 regarding the development of new antihyperglycemic drugs. The guidance expanded the scope for the approval of novel antihyperglycemic drugs by mandating CVOTs for safety. A few long-term CVOTs on dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter 2 inhibitors have been completed, while others are ongoing. SUs, which constitute one of the key antihyperglycemic agents used for the management of type 2 diabetes mellitus (T2DM), have been used as comparator agents in several CVOTs. However, the need for CVOTs on modern SUs remains debatable. In this context, a multinational group of endocrinologists convened for a meeting and discussed the need for CVOTs of modern SUs to evaluate their utility in the management of patients with T2DM. At the meeting, CVOTs of modern SUs conducted to date and the hypotheses derived from the results of these trials were discussed. Review results The expert group analyzed the key trials emphasizing the CV safety of modern SUs and also reviewed the results of various CVOTs in which modern SUs were used as comparators. Based on literature evidence and individual clinical insights, the expert group opined that modern SUs are cardiosafe and that since they have been used as comparators in other CVOTs, CVOTs of SUs are not required. Conclusion Modern SUs can be considered a cardiosafe option for the management of patients with diabetes mellitus and CV disease; thus CVOTs among individuals with T2DM are not required.

Type 2 diabetes mellitus (T2DM) is a progressive disease with multifactorial etiology. The first-line therapy includes monotherapy (with metformin), which often fails to provide effective glycemic control, necessitating the addition of add-on therapy. In this regard, multiple single-dose agents formulated as a single-dose form called fixed-dose combinations (FDCs) have been evaluated for their safety, efficacy, and tolerability. The primary objective of this review is to develop practice-based expert group opinion on the current status and the causes of concern regarding the irrational use of FDCs, in Indian settings. After due discussions, the expert group analyzed the results from several clinical evidence in which various fixed combinations were used in T2DM management. The panel opined that FDCs (double or triple) improve patient adherence, reduce cost, and provide effective glycemic control and, thereby, play an important role in the management of T2DM. The expert group strongly recommended that the irrational metformin FDC's, banned by Indian government, should be stopped and could be achieved through active participation from the government, regulatory bodies, and health ministry, and through continuous education of primary care physicians and pharmacists. In T2DM management, FDCs play a crucial role in achieving glycemic targets effectively. However, understanding the difference between rational and irrational FDC combinations is necessary from the safety, efficacy, and tolerability perspective. In this regard, primary care physicians will have to use a multistep approach so that they can take informed decisions.

Objective: To determine the prevalence of thyroid dysfunction (TD) and to identify risk factors which are associated with TD in Type 2 Diabetic (T2DM) patients attending the Diabetes Clinic, National Hospital of Sri LankaMethod: A descriptive cross sectional study was carried out at the Diabetes Clinic, National Hospital of Sri Lanka. Study subjects were selected by simple random sampling method and data was collected using an interviewer administered data collection form. TD was assessed by performing 3rd generation TSH and when required FT4/FT3 levels were measured. Statistical analysis was done using Pearson’s Chi-square test, Fisher exact test, Mann Whitney U test and Wilcoxon Rank Sum test and P value < 0.05 was considered as significant.Results: TD was detected in 83 out of 393 T2DM subjects.The prevalence of TD among study subjects was 21.1% (95% CI:17.2-25.5%). The most common TD categories were subclinical hypothyroidism (9.4%, 95% CI:6.7-12.7%) and overt hypothyroidism (6.1%, 95% CI:3.9-8.9%). Subclinical hyperthyroidism and overt hyperthyroidism were detected only in 5.1% (95% CI:3.1-7.8%) and 0.5% (95% CI:0.1-1.8%) of cases respectively. The presence of TD was strongly associated with female sex (pConclusion: The prevalence of TD was 21.1% and higher prevalence was seen in T2DM patients with female sex, advancing age, presence of goitre and positive family history of thyroid disorder among 1st degree relatives. DOI: http://dx.doi.org/10.4038/sjdem.v4i1.7254Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2014; 4: 43-48

DOI: http://dx.doi.org/10.4038/sjdem.v3i2.6382 Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2013; 3: 114-122