Dangers of Sulfonylureas for Diabetes

If you doctor started you on one of the sulfonylureas to manage your diabetes, you may be significantly more likely to die early than if you take metformin. Research presented on Wednesday showed that among more than 92,000 people in the United Kingdom with type 2 diabetes those who took only sulfonylureas were 58 percent more likely to die from any cause than those who took only metformin.

The research is in an abstract, “Association between first-line monotherapy with sulfonylurea versus metformin and risk of all-cause mortality,” presented at the annual meeting of the European Association for the Study of Diabetes in Barcelona, Spain. The findings are preliminary because they haven’t been published in a peer-reviewed journal. And since the findings come from an observational study, the higher risk of death might be that doctors prescribed a sulfonylurea to sicker people. Another concern might be that Bristol-Myers Squibb, which sells Glucophage, a brand of metformin, provided financial support for the study.

Lots of us still take one of the sulfonylureas, which was the first oral drugs to help us manage type 2 diabetes. For more than half a century we have been using them — a class of drugs that includes Amaryl (glimepiride), Glucotrol XL (glipizide), and glyburide.

They are inexpensive, and our doctors are comfortable with them because they have been around for so long. When a doctor told me in 1994 that I had type 2 diabetes, he prescribed one of the sulfonylureas. At that time insulin was the only other medication that we had for diabetes, but since then many more oral medications for diabetes have become available.

The sulfonylureas help our bodies to release more insulin from the beta cells of the pancreas. Because they are working all the time, some of us have another concern. Possibly, using one of these drugs for a long time could burn out the beta cells and thereby make our diabetes progressively more difficult to manage. Last year my friend and colleague Gretchen Becker in “Sulfonylureas and Beta Cell Burnout” reviewed a study that shows that “the sulfonylureas do indeed seem to be associated with a more rapid decline in beta cell function.”

We need more research to give us definitive answers to these questions. Eventually, we will know everything. Meanwhile, I’m not suggesting that you throw out your sulfonylurea pills. But if you are taking one of these medication, talking with your doctor about it would certainly be prudent.

This article is based on an earlier version of my article published by HealthCentral.