Similar Diabetes Medicines Carry Different Hypoglycemia Risks

Adding sulfonylureas to the first-line diabetes medicine metformin is a common strategy for managing Type 2 diabetes, but different sulfonylureas carry different risks of hypoglycemia (low blood sugar), according to new research from Denmark. Approximately 29 million Americans (roughly 9% of the population) and 260,000 Danes (roughly 5% of the population) are living with Type 2 diabetes.

Sulfonylureas are one of the oldest types of diabetes medicine, having been developed in the 1940s, and work by signaling the pancreas to release insulin and by helping the body’s cells to use insulin more effectively. First-generation sulfonylureas include tolbutamide (brand name Orinase), tolazamide (Tolinase), and chlorpropamide (Diabinese), while the more commonly used second-generation sulfonylureas include glimepiride (Amaryl), gliclazide (not available in the United States), glipizide (Glucotrol and Glucotrol XL), and glyburide or glibenclamide (Diabeta, Micronase, and Glynase).


The most common side effect of these drugs is hypoglycemia. To compare the risk of lows from various sulfonlylureas, researchers conducted a meta-analysis (analysis of data from several clinical trials) of studies lasting 12–52 weeks that added sulfonylureas to metformin therapy in people with Type 2 diabetes. They found that gliclazide carried a lower risk of hypoglycemia than glipizide, glyburide, and glimepiride.

“Risk of hypoglycemia with the [sulfonylurea] agents makes the newer and more expensive antidiabetic [medicines] preferable when metformin monotherapy fails,” notes study co-author Stig Ejdrup Andersen, PhD. “However, our data indicate that the risk of hypoglycemia differs between the [sulfonylurea] agents. Thus, prescribing a [sulfonylurea] with a low risk of hypoglycemia might still be a rational and affordable alternative to many patients with Type 2 diabetes.”

Study limitations include differing definitions of hypoglycemia in the trials covered in the meta-analysis.

For more information, read the article “Risk of Low Blood Sugar Differs Among Similar Diabetes Drugs” or see the study’s abstract in the British Journal of Clinical Pharmacology. And for more information about the different classes of diabetes medicines, see this series by certified diabetes educator Amy Campbell.

Do you live in the area of San Diego, California? Then you may be interested in the upcoming “Taking Control of Your Diabetes” health fair at the San Diego Convention Center. Bookmark and tune in tomorrow to learn more.