Inappropriate sulfonylurea prescribing is common

  • Giorda CB & al.
  • Diabetes Ther
  • 30.07.2020

  • von Miriam Tucker
  • Clinical Essentials
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Takeaway

  • 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  • Patients should be monitored for risk factors; if present, prescriptions should be withdrawn or avoided.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).

Study design

  • 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).

Key results

  • 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).

Limitations

  • Relatively small sample size.
  • No qualitative information on clinical decision-making.