Real-world hypoglycemia data support continued sulfonylurea role in type 2 diabetes
medwireNews: Hypoglycemia is common among people being treated for type 2 diabetes, particularly those using insulin or a sulfonylurea, but the risk for severe episodes is only elevated among insulin users, suggest results of a prospective UK study.
Kamlesh Khunti (University of Leicester, UK) and co-authors say that the lower rate of severe hypoglycemia among sulfonylurea versus insulin users “is in agreement with findings from previous observational studies, and adds support to the continued importance of sulfonylureas as a possible therapy choice in [type 2 diabetes].”
“However, the incidence of non-severe episodes [among sulfonylurea users] still represents a significant burden, given the potential impact on an individual’s daily activities and wellbeing, the economic consequences of reduced work productivity and increased treatment costs, and the associated increased risk of severe events,” they add.
Over a 12-month period, 325 participants from 17 primary care practices throughout the UK kept a diary of blood glucose levels and hypoglycemia episodes.
During this time, 39.2% reported experiencing hypoglycemia, of whom 92% experienced at least one non-severe (self-treated) episode and 17% had at least one severe episode (requiring external help).
The incidence of non-severe episodes was highest among insulin users (n=93), at 3.84 events per person–year, followed by sulfonylurea users (n=107), at 1.94 events per person–year. The rates among individuals receiving metformin (n=75) or incretin‐based treatment (dipeptidyl peptidase-4 inhibitors, n=36, or glucagon-like peptide-1 receptor agonists, n=14) were 0.64 and 0.49 events per person–year, respectively.
The corresponding rates for severe hypoglycemia were 0.32, 0.09, 0.07, and 0.07 events per person–year.
The researchers calculated that, compared with metformin, participants using sulfonylureas had a significant 3.02-fold higher risk for non‐severe hypoglycemia but no increased risk for severe hypoglycemia.
By contrast, participants using insulin had significantly higher risks for both non-severe and severe hypoglycemia than those using metformin, at incidence rate ratios of 5.96 and 4.55, respectively.
In addition, older age and non-White race were both associated with a reduced risk for any hypoglycemia, whereas longer diabetes duration was associated with an increased risk for symptomatic episodes only.
Writing in Diabetes, Obesity and Metabolism, Khunti et al conclude: “The rates observed in our study indicate that hypoglycaemia episodes continue to represent a substantial burden for people with [type 2 diabetes].”
However, the authors also accept that the observational nature of the study meant they “were unable to account for participant level factors, such as reduced dietary intake/fasting, increased physical activity/exercise or alcohol consumption, which may have contributed to hypoglycaemia risk,” while the limited number of events overall (n=107) “may have limited the power to compare treatment groups.”
By Laura Cowen
medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group