- 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.
- 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.
- Consensus statement.
- Funding: AstraZeneca.