Do sulfonylureas still have a role in blood sugar and diabetes control?

At present, there are a large number of pharmacological agents available for good control of blood sugar and effectively treat type 2 diabetes (T2D).The task of making a choice for the optimal drug for any given patient a complex task. Since newer agents offer several advantages, whether and when sulfonylureas (SUs) should still be used to treat T2D is controversial. 

Expert Opinion from a European Consensus Panel to be published in the journal Diabetes Obesity Metabolism has laid down treatment guidelines and recommendations that should govern the general approach to diabetes management and optimum blood sugar and glycemic control. Although current joint EU/US guidelines address overall type 2 diabetes (T2D) management, this present European consensus paper aims to provide additional guidance on the use of sulfonylureas in T2D.

The experts summarize current local treatment guidelines in European countries, showing that sulfonylureas are still widely proposed as second-line treatment after metformin and often ranked at the same level as newer blood-sugar-lowering medications. Although, the newer agents confer greater benefits they are more costly.

Key recommendations  

1. After metformin, for second-line glucose-lowering medication, sodium-glucose cotransporter-2 inhibitors (SGLT-2is), glucagon-like peptide-1 receptor agonists (GLP-1RAs), or to a lesser extent, dipeptidyl peptidase-4 inhibitors (DPP-4is) are preferred over sulfonylureas because of minimal hypoglycemic risk.

2. Positive (GLP-1RA, SGLT-2i) or neutral (DPP-4i) cardiovascular (CV) effects.

3.Positive renal effects (SGLT-2i>>GLP-1RA>DPP-4i).

4.Neutral (DPP-4i) or positive (GLP-1RA, SGLT-2i) body-weight effects.

5.Possible longer blood sugar control and ease of use particularly in individuals with ascertained CV disease or very high CV risk, SGLT-2i or GLP-1RA is recommended as part of diabetes treatment in the absence of contraindications.

Using sulfonylureas in place of SGLT2-i and GLP-1RAs may deprive patients of key advantages and potentially important cardiorenal benefits. In subjects with ascertained cardiovascular disease or at very high cardiovascular risk, SGLT2-i and/or GLP-1RAs should be used as part of diabetes management, in the absence of contraindications.

Routine second-line sulfonylurea use may be acceptable in resource-constrained settings, with these considerations:Gliclazide may be preferred over other sulfonylureas but patient education on hypoglycemia is desirable. The use of self-monitoring of blood sugar is advised to minimize hypoglycemic side effects. The decision to use sulfonylureas instead of SGLT-2i or GLP-1RA should be strongly supported, given that sulfonylureas do not confer the potential cardiorenal protective effects of the other drug classes.

For further reference log on to :

Consoli A, Czupryniak L, Duarte R, Jermendy G, Kautzky-Willer A, Mathieu C, Melo M, Mosenzon O, Nobels F, Papanas N, Roman G, Schnell O, Sotiropoulos A, Stehouwer CDA, Tack CJ, Woo V, Fadini GP, Raz I. Positioning sulfonylureas in a modern treatment algorithm for patients with type 2 diabetes: expert opinion from a European Consensus Panel. Diabetes Obes Metab. 2020 Jun 1 [Epub ahead of print].