- Most sulfonylurea prescriptions are inappropriate.
- Patients should be monitored for risk factors; if present, prescriptions should be withdrawn or avoided.
Why this matters
- Italian (among other) national guidelines recommend limiting sulfonylurea use in patients with type 2 diabetes (T2D).
- Retrospective, 22-center, observational study in 510 adults with T2D treated with sulfonylureas (monotherapy or in combination) during 2017-2018.
- Inappropriate prescription risk (IPR) identified in patients with ≥1 risk factors: age ≥75 years, heart disease/stroke history, chronic renal insufficiency (CRI), severe hypoglycemia history, obesity, cognitive impairment, or occupation where hypoglycemia would pose danger.
- Funding: MSD Italy (unconditional support).
- Overall, 70.6% (95% CI, 66.4%-74.5%) were classified as presenting with IPR, with 60.3% having just 1 risk factor.
- Of 360 patients with IPR, risk factor rates were:
- 47.5% obesity,
- 33.3% age ≥75 years,
- 18.6% cardiovascular disease history,
- 14.1% CRI,
- 1.8% severe hypoglycemia history,
- 1.8% cognitive impairment, and
- 2.4% risky occupation.
- ORs for IPR propensity:
- 1.88 (95% CI, 1.18-3.00) for receipt of antihypertensive drugs, and
- 1.98 (95% CI, 1.10-3.56) for taking ≥1 antihypertensive, lipid-lowering, and antithrombotic agents.
- No significant difference for receiving lipid-lowering agents (OR, 1.16; 95% CI, 0.78-1.75).
- Relatively small sample size.
- No qualitative information on clinical decision-making.