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Sulphonylureas Use and Risk of Hypoglycemia

BMJ; ePub 2016 Jul 13; van Dalem, et al

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An increased risk of hypoglycemic events was observed among all users of sulphonylureas, and sulphonylurea treatment in patients with a renal function of <30 mL/min/1.73 m2. This according to a population-based cohort study of 120,803 participants that examined the association between use of sulphonylureas and the risk of hypoglycemia in relation to renal function and sulphonylurea metabolic group compared with use of metformin. Researchers found:

• The risk of hypoglycemia in current users of sulphonylureas only was significantly increased compared with current users of metformin only (aHR, 2.50).

• The higher risk in current users of sulphonylureas only was further increased in patients with an estimated glomerular filtration rate of <30mL/min/1.73 m2.

• The risk of hypoglycemia was also significantly higher in patients with a high sulphonylurea dose and in current users of glibenclamide.

• Gliclazide showed a similar risk of hypoglycemia compared with other sulphonylureas.

Citation: van Dalem J, Brouwers M, Stehouwer CDA, et al. Risk of hypoglycaemia in users of sulphonylureas compared with metformin in relation to renal functions and sulphonylurea metabolite group: Population based cohort study. [Published online ahead of print July 13, 2016]. BMJ. doi:10.1136/bmj.i3625.

Commentary: Hypoglycemia is associated with significant short and long-term adverse effects. The acute short-term dangers of hypoglycemia that we have known for years include falls and impairment of consciousness. In addition, over the last few years, a number of studies have shown that severe hypoglycemia can also cause up to a 3.5-fold increased risk of death over the subsequent 5 years.1 This study shows that sulfonylureas have over a two-fold higher risk of hypoglycemia compared to metformin. In addition, the relative risk of hypoglycemia increased to almost 5-fold in individuals with GFR <30 mL/min. When choosing which hypoglycemic medication to use, we need to carefully consider the risk of hypoglycemia, as we also consider a medication’s efficacy, cost, effect on weight, and other side effects.2 —Neil Skolnik, MD

1. McCoy RG, Van Houten HK, Ziegenfuss JY, et al. Increased mortality of patients with diabetes reporting severe hypoglycemia. Diabetes Care. 2012;35:1897–1901. doi:10.2337/dc11-2054.

2. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: A patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38:140-149. doi:10.2337/dc14-2441.

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