(A) Sulfonylurea hypoglycemic agents Sulfonylurea hypoglycemic agents are the most widely used oral hypoglycemic agents at home and abroad. Their main mechanism of action is to directly stimulate the secretion of insulin by pancreatic β-cells, which also has extra-pancreatic effects and increases insulin sensitivity, so as to achieve hypoglycemic effects. Currently, sulfonylureas are classified into 1st, 2nd and 3rd generation according to the order of their discovery, the first generation including tosylurea and chlorosulfonylurea. The second generation was used in clinical practice in the 1960s and included gliphenylurea (eugenol), glipizide (mepiquat), gliclazide (damacell), and glipizide (glucophage). Third generation glimepiride. 1. Indications: Since the main mechanism of action of sulfonylurea hypoglycemic agents is to stimulate insulin secretion, they are suitable for patients with type 2 diabetes mellitus who still have some pancreatic islet function and are still not satisfactorily controlled by diet therapy. (1) Patients with non-insulin-dependent diabetes mellitus (type 2) with middle-aged or older onset, whose hyperglycemia is not satisfactorily controlled by once diet therapy and exercise therapy. About 20-30% of patients between the ages of 20 and 40 years can start with sulfonylureas for several years without insulin therapy. (2) Patients with type 2 diabetes starting at the age of 40 or above, with fasting blood glucose >11.1mmol/L, with a disease duration of 5 years or less, who have never been treated with insulin, and who are of normal weight or obese, may also choose sulfonylureas or combine them with biguanides. (3) Some patients with slow onset type 1 diabetes have not yet completely lost their pancreatic islet B cells in the early stage, and these drugs also have a partial therapeutic effect, but in order to protect the function of the remaining pancreatic islet B cells, they should be switched to insulin or combined with insulin as early as possible. (4) In recent years, the trial and insulin combination therapy can enhance the efficacy. It is believed that for type 2 diabetic patients, sulfonylurea hypoglycemic drugs can be added after the secondary failure of insulin therapy, without having to stop using sulfonylurea hypoglycemic drugs. 2, contraindications The following diabetic patients are not suitable for taking sulfonylurea hypoglycemic drugs: (1) where pediatric diabetic patients or insulin-dependent (type 1) diabetic patients, should not apply sulfonylurea drugs. (2) Diabetic ketosis, especially with metabolic acidosis or ketoacidosis, or hyperosmolar coma is prohibited. (3) Contraindicated in patients with severe infections, hyperthermia, surgery, pregnancy, childbirth, and various acute and chronic complications of the heart, kidney, liver, and brain. (4) Contraindicated in cases of jaundice, hematopoietic system suppression, leukocyte deficiency and allergic or toxic reactions to sulfonylureas. (5) The combination of diet and exercise therapy is appropriate for patients who can be controlled by diet or who must lose weight, and should be tried only when hyperglycemia is not controlled, but diet and exercise must still be the mainstay, supplemented by drugs. Diabetic patients with the following conditions should be particularly cautious and preferably do not use sulfonylureas: (1) Diabetic patients with liver and kidney dysfunction should use them with caution: Because sulfonylureas need to be inactivated by the liver, i.e., metabolized by the liver into metabolites without hypoglycemic effect, and then excreted. When there is liver dysfunction, such as cirrhosis, the liver’s ability to inactivate these drugs decreases, and they cannot be metabolized in time, so serious and persistent hypoglycemia can easily occur, and when liver function is seriously damaged, the liver’s ability to produce glucose decreases, which may induce hypoglycemia or increase the severity of hypoglycemia, so it should be used constantly for those with liver dysfunction. (2) Sulfonylureas can make weight gain and biguanides can make weight loss. It is generally advocated that the combined medication should be used early and the dose used should be small, and then the dose should be adjusted gradually according to the blood sugar situation until the effect of satisfactory blood sugar control is obtained. For those who do not have satisfactory effect with biphasic drugs alone, sulforaphane can be added, and vice versa, for those who have primary or secondary failure of sulforaphane, biphasic drugs can also be added. (3)The combination of bivalirudin hypoglycemic drugs and sulfonylurea hypoglycemic drugs must pay attention to what kinds of drugs can be used and what kinds of people can not use, especially pay special attention to liver and kidney function. (4) Biguanides can also be used in combination with insulin. Whether type 1 or type 2 diabetes is being treated with insulin patients, want to reduce the amount of insulin or enhance the efficacy of insulin can be added to take biguanide hypoglycemic drugs. However, it should be noted that patients with type 1 diabetes who are not treated with insulin cannot be treated with biguanides alone, because these drugs must have insulin in the body in order to play a role in lowering blood sugar. (5) Sulfonylurea hypoglycemic drugs toxic side effects are generally very small, but improper use of drugs prone to hypoglycemia. Common side effects include: (1) gastrointestinal reactions. Loss of appetite, nausea, vomiting, diarrhea and abdominal pain, etc., which can subside after the drug dosage is reduced. (2) Skin reactions. Such as skin itching, erythema, urticaria, measles-like rash or maculopapular rash, etc., can gradually subside after reducing the amount of the drug, if persistently does not subside, should stop using. Occasionally, severe exfoliative dermatitis is seen, and the use of such drugs should be stopped immediately. (3) Hematologic reactions. There are leukopenia, granulocyte deficiency, thrombocytopenia, hemolytic anemia, dysplasia