Oral hypoglycaemics for diabetes: when and which?

People with non-insulin-dependent diabetes mellitus should modify their diet, avoid obesity and take regular exercise. An oral hypoglycaemic drug may be needed if these measures fail to control blood glucose, but it is now clear that they commonly cause hypoglycaemia. More than 3 million prescriptions were issued in 1988 for the sulphonylureas (eight currently available) and the biguanide, metformin. Glibenclamide is the market leader (1.4 million prescriptions in 1988), followed by metformin (950,000), chlorpropamide (280,000), tolbutamide (260,000) and gliclazide (200,000). Instituting a district policy to restrict the choice of sulphonylureas can improve care and save money.1 No new oral hypoglycaemics have been marketed since we last reviewed them2 but their place in overall management has been clarified.