Sulfonylureas and diabetes treatment

What is your opinion about sulfonylureas? Is there a place for them in the modern treatment of diabetes?

Hertzel Gerstein: Sulfonylureas have been available for the management of diabetes since the 1950s. These are old drugs, and we know a lot about them. They lower glucose levels very well when they are first used. They work by increasing pancreatic secretion of insulin regardless of the glucose level, which is one of the side effects they have, as they can cause hypoglycemia.

Unfortunately, we do not know what the effect of sulfonylurea is compared to no sulfonylurea on serious health outcomes, such as cardiovascular events, strokes, deaths, things of that nature. The reason we do not know that is because no study has explicitly tested that question. All we know is that in the studies that have used sulfonylureas to lower glucose levels, people who were randomized to the glucose-lowering therapy with a sulfonylurea had lower rates of cardiovascular events in the UK Prospective Diabetes Study (UKPDS) after about 20 years, and in the ADVANCE trial they had lower rates of renal disease, specifically, than people who did not lower the glucose levels as much.

So we know that when sulfonylureas are used to lower glucose levels, there seems to be either a neutral or beneficial effect on health outcomes, but we do not know whether there is an isolated or separate effect of sulfonylureas that is beneficial or harmful. The controversy arises because in some animal studies there have been questions whether sulfonylureas may have a harmful effect, but that has never been clearly shown in any clinical trials in people, so I think the answer is not known.