Skip to main content
SpringerLink
Log in

Glipizide

A Review of the Pharmacoeconomic Implications of the Extended-Release Formulation in Type 2 Diabetes Mellitus

  • Adis Pharmacoeconomic Drug Evaluation
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Summary

▲ Glipizide is a second generation sulphonylurea agent that is available in a Gastrointestinal Therapeutic System (GITS) extended-release formulation. Glipizide GITS provides more stable plasma drug concentrations than the immediate-release formulation and the once-daily regimen may optimise patient compliance.

▲ In patients with type 2 diabetes mellitus, glipizide GITS is at least as effective as the immediate-release formulation of glipizide in providing glycaemic control, and may have a greater effect on fasting plasma glucose levels. Any therapeutic advantage over other antidiabetic agents remains to be established, but in a preliminary report (n = 40) glipizide GITS provided better glycaemic control and produced less fasting insulinaemia than glibenclamide (glyburide).

▲ The incidence of hypoglycaemic symptoms with glipizide GITS is low (≤3%).

▲ Quality of life was improved compared with baseline after 12 weeks’ treatment with glipizide GITS 5 to 20 mg/day plus diet in a US double-blind, placebo-controlled trial in 569 patients with type 2 diabetesmellitus. Hyperglycaemic symptom—related distress decreased with glipizide GITS treatment, while hypoglycaemic symptom—related distress was not significantly increased compared with placebo plus diet. Quality of life during glipizide GITS treatment has not been compared with that during treatment with other antidiabetic agents.

▲ Monthly productivity losses related to absenteeism were $US91 (1995 values) per patient lower in the glipizide GITS group compared with the placebo group in the latter prospective study. Productivity parameters improved slightly or did not change significantly in the glipizide GITS group, but deteriorated in the placebo group. Differences in direct healthcare costs between groups were small and not comprehensively reported.

▲ Glipizide GITS was the least costly strategy for first-line therapy in a US cost-of-treatment model of the first 3 years after diagnosis of type 2 diabetes mellitus. The total per-patient cost was $US4867with glipizideGITS,$US5196 with metformin and $US5249 with acarbose (1996/1997 values).

▲ Monthly drug acquisition costs were lower, and glycosylated haemoglobin levels and patient compliance were improved, after formulary conversion from the immediate-release to the GITS formulation of glipizide in a US single-hospital retrospective analysis.

Conclusions: Glipizide GITS produced better cost outcomes than metformin and acarbose in a model of 3 years’ treatment of type 2 diabetes mellitus. Glipizide GITS had pharmacoeconomic and quality of life advantages over diet alone in the short term, but more clinically relevant comparisons with other antidiabetic agents are needed. There are limitations to the present data, but the available pharmacoeconomic data have been favourable for glipizide GITS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Table I
Table II
Table III
Table IV
Fig. 2
Table V

Similar content being viewed by others

References

  1. Lebovitz HE. Glipizide: a second-generation sulfonylurea hypoglycemic agent: pharmacology, pharmacokinetics and clinical use. Pharmacotherapy 1985 Mar-Apr; 5: 63–77

    PubMed  CAS  Google Scholar 

  2. Pfizer Inc. Glucotrol® (glipizide) tablets. Prescribing information [online]. Available from: URL: http://www.pfizer.com/hml/pis/glucotrolpi.html [Accessed 2000 Mar 27]

  3. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997 Jul; 20 (7): 1183–97

    Google Scholar 

  4. DeFronzo RA. Pharmacologic therapy for type 2 diabetes mellitus. Ann Intern Med 1999 Aug 17; 131 (4): 281–303

    PubMed  CAS  Google Scholar 

  5. American Diabetes Association. Diabetes facts and figures [online]. American Diabetes Association, 1999. Available from: URL: http://www.diabetes.org/ada/facts.asp [Accessed 2000 Mar 13]

  6. Gerich JE. Insulin resistance is not necessarily an essential component of type 2 diabetes. J Clin Endocrinol Metab 2000; 85 (6): 2113–5

    Article  PubMed  CAS  Google Scholar 

  7. Harris MI, Goldstein DE, Flegal KM, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. Diabetes Care 1998 Apr; 21 (4): 518–24

    Article  PubMed  CAS  Google Scholar 

  8. Khunti K, Goyder E, Baker R. Collation and comparison of multi-practice audit data: prevalence and treatment of known diabetes mellitus. Br J Gen Pract 1999 May: 375–9

  9. Burke JP, Williams K, Gaskill SP, et al. Rapid rise in the incidence of type 2 diabetes from 1987 to 1996: results from the San Antonio Heart Study. Arch Intern Med 1999 Jul; 159: 1450–6

    Article  PubMed  CAS  Google Scholar 

  10. American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care 1998 Jan; 21 Suppl. 1: S23–31

    Article  Google Scholar 

  11. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998 Sep 12; 352: 837–53

    Google Scholar 

  12. American Diabetes Association. The pharmacological treatment of hyperglycemia in NIDDM. Diabetes Care 1995 Nov; 18 (11): 1510–8

    Google Scholar 

  13. Vijan S, Hofer TP, Hayward RA. Estimated benefits of glycemic control in microvascular complications in type 2 diabetes. Ann Intern Med 1997 Nov 1; 127 (9): 788–95

    PubMed  CAS  Google Scholar 

  14. Rubin RJ, Dietrich KA, Hawk AD. Clinical and economic impact of implementing a comprehensive diabetes management program in managed care. J Clin Endocrinol Metab 1998; 83 (8): 2635–42

    Article  PubMed  CAS  Google Scholar 

  15. de Sonnaville JJJ, Bouma M, Colly LP, et al. Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study. Diabetologia 1997 Nov; 40: 1334–40

    Article  PubMed  Google Scholar 

  16. Alberti KGMM. The costs of non-insulin-dependent diabetes mellitus. Diabetic Med 1997 Jan; 14: 7–9

    CAS  Google Scholar 

  17. Institute for Clinical Systems Integration. Management of type 2 diabetes mellitus. Postgrad Med 1999 Jan; 105: 121–4,129–31,135–6

    Google Scholar 

  18. Feinglos MN, Bethel MA. Treatment of type 2 diabetes mellitus. Med Clin North Am 1998 Jul; 82: 757–90

    Article  PubMed  CAS  Google Scholar 

  19. Songer TJ. The economic costs of NIDDM. Diabetes Metab Rev 1992 Dec; 8: 389–404

    CAS  Google Scholar 

  20. O’Brien JA, Shomphe LA, Kavanagh PL. Direct medical costs of complications resulting from type 2 diabetes in the U.S. Diabetes Care 1998 Jul; 21: 1122–8

    Article  PubMed  Google Scholar 

  21. Grossman JA. Successful management of type 2 diabetes: are the benefits worth the costs? Practical Diabetology 1999 Jun: 12–22

  22. Leese B. The costs of diabetes and its complications. Soc Sci Med 1992 Nov; 35: 1303–10

    Google Scholar 

  23. Huse DM, Oster G, Killen AR, et al. The economic costs of non-insulin-dependent diabetes mellitus. JAMA 1989 Nov 17; 262: 2708–13

    Article  Google Scholar 

  24. Brown JB, Nichols GA, Glauber HS, et al. Type 2 diabetes: incremental medical care costs during the first 8 years after diagnosis. Diabetes Care 1999 Jul; 22: 1116–24

    Article  PubMed  CAS  Google Scholar 

  25. Moore P. Type 2 diabetes is a major drain on resources. BMJ 2000 Mar 18; 320: 732

    Article  Google Scholar 

  26. American Diabetes Association. Economic consequences of diabetes mellitus in the U.S. in 1997. Diabetes Care 1998 Feb; 21 (2): 296–309

    Article  Google Scholar 

  27. Selby JV, Zhang D, Ray GT, et al. Excess costs of medical care for patients with diabetes in a managed care population. Diabetes Care 1997 Sep; 20 (9): 1396–402

    Article  PubMed  CAS  Google Scholar 

  28. Kangas T, Aro S, Koivisto VA, et al. Structure and costs of health care of diabetic patients in Finland. Diabetes Care 1996May; 19: 494–7

    Article  PubMed  CAS  Google Scholar 

  29. Cost of diabetes is soaring, says report. Pharm J 1996 Sep 14; 257: 344

    Google Scholar 

  30. Brown JB, Pedula KL, Bakst AW. The progressive cost of complications in type 2 diabetes mellitus. Arch Intern Med 1999 Sep 13; 159: 1873–80

    Google Scholar 

  31. Lloyd A, Hopkinson PK. The impact of diabetic complications on the quality of life of patients with type 2 diabetes [abstract]. Diabetologia 1999 Aug; 42 Suppl. 1: A37

    Google Scholar 

  32. Eastman RC, Javitt JC, Herman WH, et al. Model of complications of NIDDM. II. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia. Diabetes Care 1997 May; 20: 735–44

    Article  PubMed  CAS  Google Scholar 

  33. O’Brien T, Ray N, Ganoczy D, et al. Clinical and economic outcomes of care associated with reduced levels of hemoglobin A1C in patients with Type 2 diabetes [abstract]. Diabetologia 1998 Aug; 41 Suppl. 1: A41

    Google Scholar 

  34. Gilmer TP, Manning WG, O’Connor PJ, et al. The cost to health plans of poor glycaemic control. Diabetes Care 1997 Dec; 20 (12): 1847–53

    Article  PubMed  CAS  Google Scholar 

  35. Lebovitz HE, Feinglos MN. Mechanism of action of the second- generation sulfonylurea glipizide. Am J Med 1983 Nov 30; 75: 46–54

    Article  Google Scholar 

  36. Prendergast BD. Glyburide and glipizide, second-generation oral sulfonylurea hypoglycemic agents. Clin Pharm 1984 Sep–Oct; 3: 473–85

    PubMed  CAS  Google Scholar 

  37. Brogden RN, Heel RC, Pakes GE, et al. Glipizide: a review of its pharmacological properties and therapeutic use. Drugs 1979; 18: 329–53

    Article  PubMed  CAS  Google Scholar 

  38. Pfizer Inc. Glucotrol XL® (glipizide). Extended release tablets. Prescribing information [online]. Available from: URL: http://www.pfizer.com/hml/pis/glucotrolxlpi.html [Accessed 2000 Mar 6]

  39. Simonson DC, Kourides IA, Feinglos M, et al. Efficacy, safety, and dose-response characteristics of glipizide gastrointestinal therapeutic system on glycemic control and insulin secretion in NIDDM: results of two multicenter, randomized, placebocontrolled clinical trials. Diabetes Care 1997 Apr; 20: 597–606

    Article  PubMed  CAS  Google Scholar 

  40. Blonde L, Guthrie Jr RD, Tive L, et al. Glipizide GITS is effective and safe in a wide range of NIDDM patients: results of a double-blind placebo-controlled efficacy and safety trial [abstract]. Diabetologia 1996 Aug; 39 Suppl. 1: A231

    Google Scholar 

  41. Testa MA, Simonson DC. Health economic benefits and quality of life during improved glycemic control in patients with type 2 diabetes mellitus: a randomized, controlled, double-blind trial. JAMA 1998 Nov 4; 280: 1490–6

    Article  Google Scholar 

  42. Berelowitz M, Fischette C, Cefalu W, et al. Comparative efficacy of once-daily controlled-release formulation of glipizide and immediate-release glipizide in patients with NIDDM. Diabetes Care 1994 Dec; 17: 1460–4

    Article  PubMed  CAS  Google Scholar 

  43. Leaf E, King JO. Patient outcomes after formulary conversion from immediate-release to extended-release glipizide tablets. Am J Health System Pharm 1999 Mar 1; 56: 454–6

    Google Scholar 

  44. Berelowitz M, Go E. Contrasting influences of glipizide GITS and glyburide on fasting and post Sustacal glycemia, glucose production, and 24h glucose/insulin profiles in NIDDM [abstract]. Diabetes 1996 May; 45 Suppl. 2: 285A

    Google Scholar 

  45. Cefalu WT, Bell-Farrow AD, Terry JG. Abdominal fat distribution with combination glipizide GITS/metformin treatment in Type 2 diabetics [abstract]. Diabetes 1999 May; 48 Suppl. 1: A80

    Google Scholar 

  46. Testa MA, Hayes JF, Turner RR, et al. Tolerance of glipizide GITS vs. metformin (MET) and the impact on health care utilization as measured by patient self-reports [abstract]. Diabetes 1999 May; 48 Suppl. 1: A116

    Google Scholar 

  47. Cefalu WT, Bell-Farrow A, Wang ZQ, et al. Effect of glipizide GITS on insulin sensitivity, glycemic indices, and abdominal fat composition in NIDDM. Drug Dev Res 1998 May; 44: 1–7

    Article  CAS  Google Scholar 

  48. Riddle MC, McDaniel PA, Tive LA. Glipizide-GITS does not increase the hypoglycemic effect of mild exercise during fasting in NIDDM. Diabetes Care 1997 Jun; 20: 992–4

    Article  PubMed  CAS  Google Scholar 

  49. Burge MR, Schmitz-Fiorentino K, Fischette C, et al. A prospective trial of risk factors for sulfonylurea-induced hypoglycemia in type 2 diabetes mellitus [see comments]. JAMA 1998 Jan 14; 279: 137–43

    Article  Google Scholar 

  50. Caldwell EM, Baxter J, Mitchell CM, et al. The association of non-insulin-dependent diabetes mellitus with perceived quality of life in a biethnic population: the San Luis Valley Diabetes Study. Am J Public Health 1998 Aug; 88: 1225–9

    Article  PubMed  CAS  Google Scholar 

  51. Testa MA, Simonson DC, Turner RR. Valuing quality of life and improvements in glycemic control in people with type 2 diabetes. Diabetes Care 1998 Dec; 21 Suppl. 3: C44–52

    Google Scholar 

  52. Testa MA, Simonson DC. Measuring quality of life in hypertensive patients with diabetes. Postgrad Med J 1988; 64 Suppl. 3: 50–8

    PubMed  Google Scholar 

  53. Testa MA, Simonson DC. Assessment of quality-of-life outcomes. N Engl J Med 1996; 334 (13): 835–40

    Article  PubMed  CAS  Google Scholar 

  54. Adelman MD. Glycemic control and quality of life in patients with type 2 diabetes [letter]. JAMA 1999 Jun 2; 281: 1985

    Article  Google Scholar 

  55. Harari A, Iudica-Souza C. Glycemic control and quality of life in patients with type 2 diabetes [letter]. JAMA 1999 Jun 2; 281: 1985–6

    Google Scholar 

  56. Testa MA, Simonson DC. Glycemic control and quality of life in patients with type 2 diabetes. Reply [letter]. JAMA 1999 Jun 2; 281: 1986

    Google Scholar 

  57. Ramsdell JW, Grossman JA, Stephens JM, et al. A short-term cost-of-treatment model for type 2 diabetes: comparison of glipizide gastrointestinal therapeutic system, metformin, and acarbose. Am J Manage Care 1999 Aug; 5: 1007–24

    CAS  Google Scholar 

  58. Hermann LS, Scherstén B, Melander A. Antihyperglycaemic efficacy, response prediction and dose-response relations of treatment with metformin and sulphonylurea, alone and in primary combination. Diabetic Med 1994; 11: 953–60

    Article  PubMed  CAS  Google Scholar 

  59. Chiasson J-L, Josse RG, Hunt JA, et al. The efficacy of acarbose in the treatment of patients with non-insulin-dependent diabetes mellitus: a multicenter controlled clinical trial. Ann Intern Med 1994; 121: 928–35

    PubMed  CAS  Google Scholar 

  60. Martínez MM, Bolaños E, Reviriego J. Utilization study of antidiabetic drugs in Spain during 1994 [abstract]. Therapie 1995; 50 Suppl.: 447

    Google Scholar 

  61. Simonson DC, Testa MA. Cost of oral antidiabetic therapy in patients with Type 2 diabetes [abstract]. Diabetes 1998 May; 47 Suppl. 1: A60

    Google Scholar 

  62. Zoeller J. The top 200 drugs. Am Drug 1999 Feb: 41–8

  63. Barman Balfour JA, Plosker GL. Rosiglitazone. Drugs 1999 Jun; 57 (6): 921–30

    Article  Google Scholar 

  64. Troglitazone use rejected in UK, but reaffirmed in US. Reactions 1999 Apr 2; 745: 2

    Google Scholar 

  65. Troglitazone withdrawn in the UK. Reactions 1997 Dec 13; 681: 2

    Google Scholar 

  66. US FDA says withdraw troglitazone. Reactions 2000 Apr 1; 795: 2

  67. White Jr JR. The cost of managing diabetes mellitus: focus on the oral pharmacologic management of Type II diabetes. J Manage Care Pharm 1999 Mar-Apr; 5: 113–20

    Google Scholar 

  68. Law AV, Pathak DS, Segraves AM, et al. Cost-effectiveness analyses of the conversion of patients with non-insulin-dependent diabetes mellitus from glipizide to glyburide and of the accompanying pharmacy follow-up clinic. Clin Ther 1995 Sep–Oct; 17: 977–87

    Article  PubMed  CAS  Google Scholar 

  69. Matuschka P, Vissing R. Glipizide to glyburide conversion in patients with type II diabetes mellitus. Formulary 1995 Jul; 30: 405–8

    Google Scholar 

  70. Noyes MA, Carter BL, Helling DK, et al. Evaluation of glipizide and glyburide in a health maintenance organization. Ann Pharmacother 1992 Oct; 26: 1215–20

    PubMed  CAS  Google Scholar 

  71. Alexis G, Henault R, Sparr HB. Conversion from glipizide to glyburide: a prospective cost-impact survey. Clin Ther 1992 May–Jun; 14: 409–17

    PubMed  CAS  Google Scholar 

  72. Alexis G, Henault R, Sparr HB. Conversion from glipizide to glyburide: long-term follow-up of a cost-impact survey focusing on the elderly. Clin Ther 1993 May–Jun; 15: 607–15

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Adis International Limited, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, Auckland, 10, New Zealand

    Rachel H. Foster & Greg L. Plosker

Authors
  1. Rachel H. Foster
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Greg L. Plosker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rachel H. Foster.

Additional information

Various sections of the manuscript reviewed by: M. Feinglos, Duke University Medical Center, Durham, North Carolina, USA; B. Leese, Centre for Health Economics, University of York, York, England; L. MacKeigan, Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; B. McLendon, Duke University Medical Center, Durham, North Carolina, USA; A.D. Mooradian, Division of Endocrinology, St Louis University, St Louis, Missouri, USA; M.A. Testa, Harvard School of Public Health, Boston, Massachusetts, USA.

Data Selection

Sources: Medical literature published in any language since 1983 on glipizide, identified using AdisBase (a proprietary database of Adis International, Auckland, New Zealand) and Medline. Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from the company developing the drug.

Search strategy: AdisBase search terms were ‘Glipizide’ or ‘Type-2-diabetes-mellitus’ and (‘health-economics’ or ‘pharmacoepidemiology’ or ‘prescribing’ or ‘hospitalisation’ or ‘formularies’ or ‘drug-utilisation’ or ‘meta-analysis’ or ‘therapeutic-substitution’ or ‘epidemiology’), or ‘Glipizide’ and ‘Type-2-diabetes-mellitus’. Medline search terms were ‘Glipizide’ or ‘Type-2-diabetes-mellitus’ and (‘economics’ or ‘health-policy’ or ‘quality-of-life’ or ‘models-statistical’ or ‘health-planning’ or ‘epidemiology’ or ‘guideline in pt’ or ‘practice-guidelines in pt’. Searches were last updated 01 August 2000.

Selection: Economic analyses in patients with type 2 diabetesmellitus who received Glipizide Gastrointestinal Therapeutic System. Inclusion of studies was based mainly on the methods section of the trials. Relevant background data on epidemiology and cost of illness are also included.

Index terms: Glipizide Gastrointestinal Therapeutic System, type 2 diabetes mellitus, pharmacoeconomics, therapeutic use.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Foster, R.H., Plosker, G.L. Glipizide. Pharmacoeconomics 18, 289–306 (2000). https://doi.org/10.2165/00019053-200018030-00008

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-200018030-00008

Keywords

Search

Navigation