Do Your Diabetes Meds Need an Upgrade?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Older is not always better when it comes to diabetes medications. The class of diabetes medications called sulfonylureas consists of old standard drugs like glyburide, glipizide, and Amaryl (glimepiride), and they aren’t as good as the new stuff.

First-line therapy with sulfonylureas significantly increases the risk for death in patients with type 2 diabetes when compared with treatment with metformin, yet another new study shows. We have known for years that the sulfonylureas lead to low blood sugars and are a common offender in hospitalizations for hypoglycemia. Metformin doesn’t have the potential to lower sugars dangerously and should be the mainstay of diabetes treatment.

An additional disturbing finding in this study was that the combination of metformin and a sulfonylurea (Glucovance is an example of this) was also associated with a significantly increased risk for death when compared with combination therapy with metformin and a “gliptin” medication—Janumet (Januvia + metformin) is your example here.

At this point, knowing what we know, we should all be bewildered these meds are still being used. I see the temptation—they are cheap and have been around forever—but we have seen in many studies that there is increased mortality in the combination group of metformin plus sulfonylureas (Glucovance) and with sulfonylureas alone.

How big is this “risk”? In the recent studies, there was a 58% increased risk for all-cause mortality among diabetics given sulfonylureas as their only diabetes medication.

If you are on glipizide, glyburide, and glimepiride instead of metformin you need to ask your doctor about it. The same goes for the combination of metformin + a sulfonylurea as you have a 35% increased risk for all-cause mortality compared to the combination of Januvia + metformin.

TIme to upgrade?

Dr O.

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