ADVERTISEMENT

Risks Associated With Using Sulfonylureas As A Treatment For Type 2 Diabetes

Sulfonylureas are antidiabetic drugs that have been used for more than 50 years in the treatment of type 2 diabetes. While sulfonylureas can effectively reduce elevated blood sugar levels found in patients with type 2 diabetes, they have also been linked to adverse events, such as hypoglycemia. This is important given that severe forms of hypoglycemia are known to increase the risk of cardiovascular disease and death.

To better characterize the safety profile of sulfonylureas, we initiated a research project that aimed to assess the risk of severe hypoglycemia and other serious adverse events associated with their use. In our first study, we used data from the United Kingdom Clinical Practice Research Datalink for 14,012 patients with type 2 diabetes who started treatment with sulfonylureas between 1998 and 2012 matched to 14,012 patients with type 2 diabetes who started treatment with metformin in the same period. Metformin is the drug usually recommended as first-line treatment according to most guidelines, including those recommended by the American Diabetes Association. We found that compared with metformin, sulfonylureas were associated with a more than 4-fold elevated risk of severe hypoglycemia.

ADVERTISEMENT

In a subsequent study also using data from the United Kingdom Clinical Practice Research Datalink, we considered 77,138 patients with type 2 diabetes who started treatment with metformin between 1998 and 2013. Patients who subsequently added or switched to a sulfonylurea were identified and matched to a similar patient who continued metformin alone. We found that compared with continuing metformin alone, adding or switching to sulfonylureas was associated with a more than 7-fold elevated risk of severe hypoglycemia.

In the same study, we also assessed the cardiovascular safety of sulfonylureas. Compared with continuing metformin alone, adding or switching to sulfonylureas was associated with a 26% elevated risk of myocardial infarction and a 28% elevated risk of death. There was also a trend towards elevated risks of ischemic stroke and cardiovascular death with sulfonylurea use. Importantly, compared with adding sulfonylureas to metformin treatment, switching to sulfonylureas from metformin treatment was associated with a greater risk of myocardial infarction and death, but no differences were found with respect to ischemic stroke, cardiovascular death, or severe hypoglycemia.

Overall, our results argue against the use of sulfonylureas as first-line treatment when metformin is not tolerated or contraindicated. They also suggest that using sulfonylureas as second-line treatment could increase the risk of serious adverse events, especially when sulfonylureas are prescribed without metformin.

Patients with type 2 diabetes should try to use metformin for as long as possible. Moreover, those in need of treatment escalation that are also at increased cardiovascular risk could discuss with their treating physicians about other second-line treatments instead of sulfonylureas.

ADVERTISEMENT

Further observational studies are needed to replicate our findings. Moreover, future research should aim to assess the longer-term risks of sulfonylureas as second-line treatments given the relatively short follow-up of our study. Finally, there is a need for studies comparing sulfonylureas with newer antidiabetic agents such as glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors.

These findings are described in the article entitled Sulfonylureas as Initial Treatment for Type 2 Diabetes and the Risk of Severe Hypoglycemia, recently published in the American Journal of Medicine. This work was conducted by Oriana Yu, Laurent Azoulay, Hui Yin, Kristian B. Filion, and Samy Suissa from the Jewish General Hospital, Montreal. These findings are also described in the article entitled Sulfonylureas as second line drugs in type 2 diabetes and the risk of cardiovascular and hypoglycaemic events: population based cohort study, recently published in the journal BMJ. This work was conducted by Antonios Douros, Sophie Dell’Aniello, Oriana Hoi Yun Yu, Kristian B Filion, Laurent Azoulay, and Samy Suissa from the Jewish General Hospital, Montreal. 

Comments

READ THIS NEXT

When Is Hawaii’s Hurricane Season?

Hawaii’s hurricane season¬†runs from July to December, which means if you are planning a big trip to Hawaii it is […]

Hydrological And Shallow Flow Modeling: Solutions Converge

Hydrological modeling is at the core of many environmental, agricultural, and engineering applications, research, and practices. Decision-making on managing our […]

Can We Use Entomopathogenic Fungi As Endophytes For Biological Control Of The Horse-Chestnut Leaf Miner?

The horse-chestnut leaf miner, Cameraria ohridella (Lepidoptera, Gracillariidae), is a major pest of horse-chestnut trees (Aesculus hippocastanum) in Europe. This […]

The Manual Method For Shrimp Spermatophore Extrusion May Cause Melanization And A Progressive Loss Of The Male Reproductive Quality

The production of domesticated shrimp broodstock is an expensive process which also requires time. However, the techniques currently used in […]

Climate Change Stressors Threaten Blue Crab Populations

Billions of larval blue crabs, or zoeae, are spawned each year into the many estuaries and bays of the Atlantic […]

When Should Herbivores Scrounge For Food From Other Group Members?

At some point in our lives, we have all had at least one friend that constantly mooched off us. You […]

Classifying Sesame Oil Seed Varieties And Origins Using Mass Spectrometry

The quality and authenticity of vegetable oils are of importance not only for their nutritional value but also for their […]

Science Trends is a popular source of science news and education around the world. We cover everything from solar power cell technology to climate change to cancer research. We help hundreds of thousands of people every month learn about the world we live in and the latest scientific breakthroughs. Want to know more?