HOW SAFE ARE SULPHONYLUREAS IN THE MANAGEMENT OF T2DM?

Sulphonylureas has been with us since the start of my medical career. It is cheap ( almost dirt cheap ), and effective. But is it safe? Remember Daonil, Diamicron, Amaryl, etc etc.
I must say that when I first looked into the data on UKPDS 1 earlier on in my medical career, I felt that it was not safe and continued to teach and practise so. My learned Diabetologist friends tell me that I am wrong and there is not enough data to say so. I suppose that must be why they have allowed the government to still purchase sulphonylureas.
Well, at the present meeting of the European Association for the Study of Diabetes ( EASD ) 2013, at Barcelona, two papers were presented on this subject by Dr Currie Crag from the University of Cardiff.

In the first study, he analysed the databank of the UK Clinical Practice Research Datalink of 10 million. From these 10 million, he found 15, 687 diabetics who received a sulphonylurea as first line therapy and 76,811 who received metformin alone. On followup, there were 44.6 deaths per 1,000 patient years in Gp 1, compared to 13.6 deaths per 1,000 patient years in Gp 2. This was a difference of 58%.

In the second study, using the same database, they compared 33,983 patients who received metformin + sulphonylurea as secondline therapy Vs 7,864 patients who received metformin + DDP4. On followup, there were 16.9deaths per 1,000 patient years in Gp 1, versus 7.3 deaths per 1,000 patient years in Gp 2, a difference of 35%.

I must say that the large difference in outcome from such a strong databank, though  not conclusive provides very compelling data, to ask those still using sulphonylureas to seriously reconsider. We do need a large RCT to show this beyond a shadow of doubt. We are agents of healing and good health, not angels of death.

Sulphonylureas are cheap and effective in lowering blood sugar, but are they safe?