Do sulfonylureas still have a role in modern T2D management?

  • Consoli A & al.
  • Diabetes Obes Metab
  • 01.06.2020

  • von Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Although current joint EU/US guidelines address overall type 2 diabetes (T2D) management, this European consensus statement provides specific additional guidance on sulfonylurea use in T2D.
  • Newer agents confer greater benefits but are more costly.

Key recommendations  

  • After metformin, for second-line glucose-lowering medication, sodium-glucose cotransporter-2 inhibitors (SGLT-2is), glucagon-like peptide-1 receptor agonists (GLP-1RAs), or to a lesser extent, dipeptidyl peptidase-4 inhibitors (DPP-4is) are preferred over sulfonylureas because of:
    • Minimal hypoglycemic risk.
    • Positive (GLP-1RA, SGLT-2i) or neutral (DPP-4i) cardiovascular (CV) effects.
    • Positive renal effects (SGLT-2i>>GLP-1RA>DPP-4i).
    • Neutral (DPP-4i) or positive (GLP-1RA, SGLT-2i) body-weight effects.
    • Possible longer glycemic durability.  
    • Ease of use.
  • Particularly in individuals with ascertained CV disease or very high CV risk, SGLT-2i or GLP-1RA is recommended as part of diabetes treatment in the absence of contraindications.  
  • Routine second-line sulfonylurea use may be acceptable in resource-constrained settings, with these considerations:
    • Gliclazide may be preferred over other sulfonylureas.
    • Patient education on hypoglycemia is desirable.
    • The use of self-monitoring of blood glucose is advised to minimize hypoglycemic side effects.
    • The decision to use sulfonylureas instead of SGLT-2i or GLP-1RA should be strongly supported, given that sulfonylureas do not confer the potential cardiorenal protective effects of the other drug classes.

Study design

  • Consensus statement.
  • Funding: AstraZeneca.