Sulfonylureas (SH for short) are among the oldest oral antidiabetic drugs and have been used for decades for type 2 diabetes. They directly stimulate the pancreas to release insulin - even if blood sugar is not actually elevated. This makes them very effective, but carries a higher risk of hypoglycemia and weight gain.
Mode of action
Sulfonylureas bind to receptors on beta cells in the pancreas. This causes potassium channels to close, the cell depolarizes and insulin is released - regardless of the current blood sugar level.
Important active ingredients and preparations (as of 2026)
| active ingredient | Brand names | Typical dosage |
|---|---|---|
| Glimepiride | Amaryl, various generics | 1–6 mg once daily (morning) |
| Gliclazide | Diamicron Uno | 30–120 mg once daily (sustained release) |
| Glibenclamide | Euglucone, various generics | 1.75-10.5 mg 1-2 times daily |
Advantages
- Very strong blood sugar-lowering effect (HbA1c reduction 1.0–1.5%)
- Cheaper than a generic
- Many years of experience and good data
Disadvantages and risks
- Increased risk of hypoglycemia (especially in the elderly or irregular diet)
- Weight gain (average 2-4 kg)
- Possible “secondary failure” after a few years (beta cells become exhausted)
- Glibenclamide is no longer recommended in elderly patients and renal insufficiency
Further information:
→ Diabetes mellitus – knowledge and overview
→ Why hyporest
→ Type 2 diabetes
Sources
- German Diabetes Society (DDG). S3 guideline “Type 2 diabetes”. As of 2025. Available at: www.deutsche-diabetes-gesellschaft.de/leitlinien.
- American Diabetes Association. Standards of Medical Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1). Available at: diabetesjournals.org.
- Robert Koch Institute (RKI). Federal health reporting – diabetes mellitus in Germany. Berlin 2024.
- International Diabetes Federation (IDF). IDF Diabetes Atlas. 11th edition. Brussels 2025. Available at: diabetesatlas.org.
Important note:
The information in this encyclopedia article is intended solely for general and non-binding information. They do not replace medical advice, diagnosis or therapy. If you have any health questions or complaints, please always consult a doctor or qualified healthcare professional. The content was created with the greatest possible care, but errors cannot be completely ruled out.
Last updated: February 26, 2026
