Optimizing Type 2 Diabetes Management: The Efficacy and Safety of Gliclazide in Clinical Practice

Abstract Sulfonylureas have been used in type 2 diabetes (T2D) management for over six decades, particularly when the use of metformin alone is insufficient. Despite their efficacy, concerns about hypoglycemia and cardiovascular risks have limited their use. Among sulfonylureas, gliclazide modified-release (MR formulation) stands out for its favorable pharmacological profile. This review evaluates its efficacy, safety, and clinical relevance in T2D management. A literature review was conducted using PubMed, Embase, and Scopus databases to identify relevant studies published up to July 2024. Data from randomized controlled trials, observational studies, meta-analyses, and real-world evidence in English comparing the efficacy of gliclazide with that of other sulfonylureas and oral antidiabetic drugs were analyzed. Gliclazide MR is associated with significant glycemic control and a lower risk of hypoglycemia than other sulfonylureas, making it a safer choice. The ADVANCE trial clearly showed its CV safety, laying aside the concerns about CV risk with sulfonylureas. Additionally, gliclazide MR’s once-daily dosing regimen enhances patient adherence, making it a practical choice for the long-term management of T2D. Furthermore, gliclazide MR has demonstrated cardiovascular neutrality and possesses antioxidant properties that protect pancreatic β -cells, potentially preserving their function and delaying the progression of T2D. In the context of contemporary T2D management, gliclazide MR remains an important option, particularly in resource-limited settings where cost is a concern. Its favorable efficacy, safety profile, and ease of use make it an effective component of treatment regimens for patients requiring additional glycemic control after metformin usage.