Endocrine Abstracts

Introduction: A novel classification of adult onset DM into five subgroups: Severe Autoimmune Diabetes (SAID); Severe Insulin-Deficient Diabetes (SIDD); Severe Insulin-Resistant Diabetes (SIRD); Mild Obesity-Related Diabetes (MOD); and Mild Age-Related Diabetes (MARD) has been postulated. We aim to formulate a consensus statement towards reassessing gliclazide use based on cluster classification of diabetes mellitus

Methods: A virtual collaborative educational initiative was convened from November-December 2022, through a series of 10 nationwide virtual interactive meetings by leading diabetologists-endocrinologists (n=150) at the forefront of diabetes care (RECLIDE Study Group). The cumulative clinical experience was approximately 4,000-man-years, who rated their level of agreement for 13 questions with each item on a 5-point Likert scale. This was preceded by a contemporary evidence-based discussion on the contemporary updates for gliclazide and novel cluster based definition of diabetes. Weighted mean for the Likert scale was calculated and consensus was pre-defined as a score > 50. GraphPad 9.4.0 and ANOVA were used for statistical analysis

Results: The highest agreement score was as follows for the consensus statements: early intervention with gliclazide is associated with reduction in risk factors and better self-management of T2DM (124), gliclazide differs from other sulfonylureas (SUs) in several respects and may provide a suitable option for some patients with T2D (124), gliclazide, among SUs has minimal risk of hypoglycemia (124). This was followed by that, gliclazide is relevant for maturity-onset diabetes of the young (MODY) (115), gliclazide is a relevant SU in T2DM who are inclined to fasting during Ramadan, the distinctive “Structure Activity Relationship’ of gliclazide contributes to determine its clinical characteristics (114), gliclazide is relevant for mild age-related diabetes (MARD, cluster 5) (98), relevant for mild obesity-related diabetes (MOD, cluster 4) (62). The highest mean response scores (±SD, 95% CI) for consensus were for agree (54.7±19.2, 95% CI 43.1 to 66.4) followed by strongly agree (27.6±19.7, 95% CI 14.3 to 40.9), neither agree nor disagree (23±21.5, 95% CI 10 to 36.1), disagree (14.1±13.5, 95% CI 4.3 to 23.8), and strongly disagree (4.5±5, 95% CI -3.4 to 12.4).

Conclusions: We observed a high preference for the usage of gliclazide in mild age-related diabetes cluster and mild obesity-related diabetes cluster. Despite the evolution of wide therapeutic armamentarium for management of T2DM, gliclazide still holds a distinctive place in clinical practice. Gliclazide has stood the test of time and it appears that gliclazide would continue to contribute towards the patient-oriented diabetes care.