Sulfonylureas Can Sometimes Cause Hypoglycemia

After metformin, sulfonylureas are a common second choice among oral drugs to treat type 2 diabetes. This class of pills—which include drugs such as glimepiride, glipizide, and glyburide—has a long name, and a long history too.

Sulfonylureas have been around since the mid-1950s, making them the first type of oral drug ever used to treat patients with type 2 diabetes.

These drugs stimulate the beta cells of the pancreas to make more insulin. Studies show they can help people control their blood sugar. That's the good news. The not-so-good news? If you take sulfonylureas, you may be at higher risk for low blood sugar.

"Sulfonylureas have the advantage of being cheap, but they can cause too low of a blood sugar and there's weight gain," says Daniel Einhorn, MD, an endocrinologist and medical director of the Scripps Whittier Institute for Diabetes in La Jolla, Calif.

Newer "second generation" sulfonylureas have fewer side effects and are often used in combination with metformin.

Researchers at Johns Hopkins University in Baltimore recently examined sulfonylureas as part of a larger analysis of oral diabetes drugs.

"Although they are not clearly superior to newer agents, sulfonylureas remain a reasonable alternative as second-line therapy, especially if cost is an issue," they conclude. The study appeared in the Annals of Internal Medicine.