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So, as it relates to the heart, glimepiride is save otherwise?

"Oral hypoglycemic drugs, including glimepiride, have been associated with increased cardiovascular mortality. Talk to your doctor about the possible risks, benefits, and alternatives of using this drug for your condition."

Check that webpage with that quote. Consider saving it to your favorites. Do the same for the homepage of the next two links. I've found them to be reliable sources of medical information. The first, Medlineplus, is written for the general public.

I thought I remembered reading an entry that was restricted just to sulfonylureas in the 1990s in the PDR, which is just a collection of the product information slips that manufacturers submit to the FDA. Since that time Rezulin (troglitazone), an oral agent described as an insulin sensitizer, was introduced and then later withdrawn from the market. Two similar drugs, Avandia (rosiglitazone) and Actos (pioglitazone), with the same mechanism of action, but less liver toxicity, are still on the market.

Here's more information about glimepiride.

Your question highlights the problem of type 2 diabetes if it can't be controlled by diet and exercise. Type 2 diabetes is characterized by insulin resistance. The excess insulin, i.e. hyperinsulinemia, needed to get blood glucose to normal or near normal levels is now considered problematic itself, whether it is from endogenous insulin prompted by sulfonylureas' effect on the pancreas or exogenous insulin self administered by syringes.

Patient compliance is better with pills as opposed to needles. IMHO, you probably have less blindness and kidney disease, i.e. microvascular disease, using pills. As for macrovascular disease, e.g. MI and stroke, "Intensive Glycemic Control Fails to Cut Cardiovascular Risk: Focus on blood pressure, lipid changes.." IIRC, further subgroup analysis of one or both of the ACCORD and ADVANCE(entered as keywords) studies showed that if the patients only had type 2 diabetes as their initial diagnosis, their outcomes were better. Both insulin and oral agents were used.