Sulphonylureas Linked To Higher Risk of Hypoglycemia: Study

Some patients with kidney problems who use Sulphonylureas for treatment of diabetes may face an increased risk of dangerously low blood glucose levels, according to the findings of new research. 

In a study published this month in the medical journal The BMJ, a group of researchers indicate that type 2 diabetics using a class of drugs known as sulfonylureas, may be at risk of suffering hypoglycemic events when compared to those using only metformin, cautioning physicians to further evaluate the kidney function of patients prior to setting treatment programs.

Sulphonylureas are a class of organic compounds widely used in diabetes drugs for the management of diabetes mellitus type 2, increasing insulin release from the beta cells in the pancreas. The class has been seen as an alternative to other common diabetes drugs, such as metformin.

Several types of sulphonylureas medications have been shown to cause hypoglycemic events in patients, potentially causing episodes of seizures, unconsciousness, and various other hazardous symptoms.

Hypoglycemia is a serious and potentially fatal event that occurs when the body’s blood glucose level drops below normal, causing some bodily functions to shut down. These episodes commonly cause symptoms of nausea, vomiting, mental confusion and unresponsiveness.

Researchers from the Netherlands reviewed medical data involving 120,803 new users of non-insulin diabetes drugs, from the Clinical Practice Research Datalink database between 2004 and 2012, to determine the association between uses of sulphonylureas and the risk of hypoglycemia in relation to kidney function and sulphonylureas metabolic group compared with the use of metformin. The study focused on dosage levels, type of medication used and risks of hypoglycemia incidents.

Sulphonylurea users were found to have lower kidney function when directly compared to metformin users or any other non-insulin antidiabetic medication uses. Moreover, sulphonylurea users were also found to be more prone to cardiovascular diseases when compared to the other diabetes medication users.

According to the data collected, the risk of hypoglycemia in current users of sulphonylureas was nearly 2.5 times higher when compared to users only receiving metformin, and these events were even more likely to occur in patients with decreased kidney function.

Researchers found patients receiving higher than average doses of sulphonylureas were at significantly higher risks for low blood sugar events, with gliclazide being the highest causing drug in its class for hypoglycemic events.

The study identified gliclazide as the most commonly used form of sulphonylureas medications chosen in other countries. The newly presented data could potentially change the way physicians approach choosing diabetic treatment programs.

The findings appear to back up another study published in The BMJ in May, which linked the risk of hypoglycemia to a number of diabetes drugs, including combining sulphonylureas with dipeptidyl peptidase-4 (DPP-4) inhibitors like Onglyza and Januvia.

Although sulphonylureas are listed by the World Health Organization in the Model List of Essential Medicines, the potential side effects were known to include hypoglycemia, cholestasis and cholestatic jaundice. However, studies have linked the medication to increased heart risks including heart disease, heart attack, stroke and cardiovascular death.

On September 16, 2013, new research was published in the medical journal Diabetic Medicine indicating 33 studies involving more than 1.3 million patients found higher rates of cardiovascular-related hospitalization and death among users of sulphonylureas.