Sulfonylureas in diabetes

Dr Chantal Mathieu is a professor of medicine at KU Leuven (Belgium) and chair in the Division of Endocrinology at UZ Leuven.

Is there still a place for sulfonylureas in the management of older patients with diabetes?

Chantal Mathieu, MD, PhD: It is a very interesting question. I think we could even ask whether there is still a place for sulfonylureas at all in people with type 2 diabetes, not only in the elderly.

Sulfonylureas are very good glucose-lowering agents but they are notorious for causing hypoglycemia and weight gain. When you look at the new American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) consensus, it is clear that we have downgraded the role of sulfonylureas. First of all, if you look at patient characteristics and at the big outcome trials, cardiovascular but also renal, we have no data on sulfonylureas, so in individuals with cardiovascular disease or renal disease [sulfonylureas are not used] very early on. If you also look at people where the priority is to avoid hypoglycemia or to avoid weight gain, again, sulfonylureas are not very high on the list of agents that are to be used.

We limit the use of sulfonylureas to patients who have problems with access to the newer agents that are more expensive, and there we clearly say that you can use sulfonylureas but we suggest using them in lower doses and also repeating and intensifying education of patients on the risks of hypoglycemia, how to avoid hypoglycemia, and how to avoid weight gain.

Overall, there is a smaller role for sulfonylureas in all people with type 2 diabetes, and in particular in those elderly, frail individuals, where hypoglycemia is really not what you want. We place sulfonylureas lower on the list of agents that we want to use for treating hyperglycemia.