Sulphonylureas in the management of type 2 diabetes: To be or not to be?

Abstract

Sulphonylureas (SUs) for a long time occupied an essential role in the management of type 2 diabetes (T2D) as an alternative or a complement to metformin. However, the launch of new oral antidiabetic drugs (OADs), firstly DPP-4 inhibitors (gliptins) and more recently SGLT2 inhibitors (gliflozins), has markedly changed the scene. Indeed, in contrast to SUs, these new OADs (of course more expensive) offer the advantage of a very low risk of hypoglycaemia and a beneficial impact on bodyweight. Furthermore, while gliptins showed good cardiovascular safety, gliflozins have proven to exert both a cardiovascular and renal protection in patients at high risk. This article discusses the current place to be reserved to SUs in the treatment of T2D, after a short recall about the risk of hypoglycaemia and the cardiovascular safety. Contrasted positions still remain in the international literature which translate into different guidelines between countries, especially due to economic constraints. SUs keep a place in the management of T2D, yet it becomes more and more limited. For sure, SU should be avoided among elderly frailty people and patients at high risk of hypoglycaemia.