Adding a Gliptin to a Sulfonylurea Is Associated with Excess Hypoglycemia

Summary and Comment |
May 12, 2016

Adding a Gliptin to a Sulfonylurea Is Associated with Excess Hypoglycemia

  1. Paul S. Mueller, MD, MPH, FACP

One episode of hypoglycemia can be expected for every eight patients treated for 1 year with this combination.

  1. Paul S. Mueller, MD, MPH, FACP

Dipeptidyl peptidase-4 inhibitors (“gliptins”) are oral drugs used to treat patients with type 2 diabetes who don't respond to, or are intolerant of, metformin and those who don't achieve adequate glycemic control with other drugs, such as sulfonylureas. In this meta-analysis, researchers determined whether adding a gliptin to a sulfonylurea (usually glyburide or glimepiride) raises risk for hypoglycemia in people with type 2 diabetes.

Researchers analyzed data from 10 randomized, controlled trials (≈6500 participants; mean ages, 55–75; mean glycosylated hemoglobin levels, 7.7%–8.6%). Relative risk for hypoglycemia was 52% higher in participants who received gliptins and sulfonylureas than in those who received placebo and sulfonylureas. The number of patients who had to be treated with a gliptin to cause 1 episode of hypoglycemia (i.e., number needed to harm) decreased from 17 (for patients treated for ≤6 months) to 8 (for patients treated for >12 months). Results were similar when the researchers excluded trials in which insulin use was allowed and those that lacked clear definitions of hypoglycemia. Risk for hypoglycemia was similar for low- and high-dose gliptins.

Comment

In this analysis, adding a gliptin to a sulfonylurea led to excess risk for hypoglycemia of more than 50%. These findings are not surprising: Sulfonylureas raise insulin levels directly and are a well-known cause of hypoglycemia, whereas gliptins raise incretin levels, which inhibit glucagon release and raise insulin levels indirectly. The authors recommend decreasing sulfonylurea doses when initiating gliptins.

Editor Disclosures at Time of Publication

  • Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication Consultant / advisory board Boston Scientific (Patient Safety Advisory Board) Editorial boards Medical Knowledge Self-Assessment Program (MKSAP 17 General Internal Medicine Committee); MKSAP 17 General Internal Medicine (author/contributor) Leadership positions in professional societies American Osler Society (Vice President)

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