First-line sulfonylureas may increase hypoglycemia risk in type 2 diabetes
medwireNews: Patients initiating treatment for type 2 diabetes with sulfonylureas are more than four times as likely to be hospitalized with hypoglycemia as those treated with metformin, population-based study data show.
“Given the increased morbidity and mortality associated with severe hypoglycemia, clinicians should consider alternative hypoglycemic agents that are associated with a lower risk of hypoglycemia for initial monotherapy for treatment of type 2 diabetes when metformin is contraindicated,” Samy Suissa (Jewish General Hospital, Montreal, Quebec, Canada) and co-authors remark.
Suissa and team used data from a large UK primary care database linked to hospitalization data to propensity match 14,012 type 2 diabetes patients aged 40 years and older who initiated sulfonylurea treatment between 1998 and 2012 with 14,012 patients who initiated treatment with metformin.
During a mean treated follow-up time of 1.4 years, a total of 94 patients developed severe hypoglycemia, defined as that needing hospitalization, of whom 20 had secondary diagnoses for falls, seizures, stroke, or death during the same admission.
The researchers report in The American Journal of Medicine that the incidence of severe hypoglycemia was significantly higher in the patients receiving sulfonylureas compared with those receiving metformin, at 4.1 versus 0.9 events per 1000 person–years, which was equivalent to a 4.5-fold increased risk in multivariate analyses.
“[T]his risk increase occurred soon after treatment initiation and progressed with continuing treatment,” write Suissa et al.
Stratified analyses showed that the risk for hypoglycemia associated with sulfonylurea use tended to be higher among women, patients over 65 years of age, and those with a history of renal disease, but the differences were not statistically significant.
Patients with a baseline glycated hemoglobin level above 8% also had a tendency for an increased risk for hypoglycemia while taking sulfonylureas, compared those with a lower baseline level.
The researchers speculate that this could be due to the treating physician overestimating the required sulfonylurea dose but say that “further studies are required to confirm this result.”
By Laura Cowen
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