Taking Sulfonylureas With or After Metformin May Raise Heart and Hypoglycemia Risks in People With Type 2 Diabetes Hypoglycemia

I Am Reactive Hypoglycemic | Minnie Talks

Why Does Type 2 Diabetes Cause Your Feet to Go Numb?

Why You Should Add a Nutritionist to Your Diabetes Team

Type 2 Diabetes Diet: Easy Ways to Revamp Your Brown-Bag Lunch

How Positive Self-Talk Can Help You Manage Type 2 Diabetes

Taking Sulfonylureas With or After Metformin May Raise Heart and Hypoglycemia Risks in People With Type 2 Diabetes

The study results support prior research on the potential harms of using sulfonylureas as a second-line treatment.

How Much Do I Have to Exercise to Reduce My Risk of Type 2 Diabetes?

Using prescribed medication is key for blood sugar control, but research shows certain drugs may hurt your ticker.

People with type 2 diabetes often take the first-line drug metformin to help control their blood sugar. If the

stops working, they may turn to second-line medications called

that suggests these drugs are tied to a greater prevalence of

This investigation found that switching to sulfonylureas from metformin boosts the chances of having a

, dying from any cause, and experiencing extreme hypoglycemia.

But further analysis found that continuing metformin along with sulfonylureas may be safer than switching. Hypoglycemia

should try to use metformin for as long as possible,” says one of the study's authors, 

, a professor in the departments of epidemiology, biostatistics, and occupational health at McGill University in Montreal. “Moreover, in case of an increased cardiovascular risk, they could discuss with their treating physicians about other second-line treatments instead of sulfonylureas.”

A Closer Look at How Researchers Conducted the Study on Sulfonylureas

Dr. Suissa and his colleagues came to these conclusions after reviewing the health records of 77,138 individuals with type 2 diabetes who began taking metformin between 1993 and 2013.

A total of 25,699 of these participants added or switched to sulfonylureas. During a follow-up period of about a year, these people had a 26 percent higher chance of heart attack and a 24 percent greater chance of

compared with those who stuck with only metformin. Their likelihood of dying from any cause increased by 28 percent, and they were about eight times more likely to have extreme hypoglycemia.

Study authors noted that those who continued to take metformin along with sulfonylureas had better health outcomes than those who switched to just the sulfonylureas. Those taking the second-line therapy without metformin were 51 percent more likely to have a heart attack and 23 percent more likely to die from any cause. (The risk of having a stroke or extreme hypoglycemia between these two groups was about the same.)

Why were the results better in the group that took both drugs? Robert Courgi, MD, an endocrinologist with Northwell Health in Huntington, New York, who wasn’t involved in the study, says that maybe those taking metformin and sulfonylureas were able to achieve blood sugar goals while taking a lower dose of a sulfonylurea.

How People With Type 2 Diabetes Can Help Stabilize Their Blood Sugar

Why Sulfonylureas May Trigger Health Problems in Some People

Still, Dr. Courgi stresses that this study confirms the negative side effects of sulfonylureas that have been observed for many years.

[AACE] lists sulfonylureas as dead last [for treatment] because of all the adverse reactions involved with them,” he says. “Sulfonylureas in and of themselves are not toxic to the heart, but they can make the blood sugar low, and when the sugar goes low, the body releases adrenaline to make the sugar go high. When you release

, the amount of oxygen your heart needs to beat increases, and that’s why there’s a risk of a heart attack with this drug.”

Suissa adds that the adverse reaction of hypoglycemia associated with these drugs has been implicated in the development of irregular heartbeats, called

, and a lack of blood flow and oxygen to the heart muscle, called cardiac ischemia. Furthermore, sulfonylureas are also connected with weight gain, which is another important risk factor for heart attack.

“Say you’re 60 years old with diabetes and already have coronary artery disease,” says Courgi. “Now you take sulfonylureas and your sugar may drop to 55 — the adrenaline gets released, the heart works overtime, and bang! You may get a heart attack.”

, the health information service of the National Library of Medicine, warns that a blood sugar level below 70 milligrams per deciliter (mg/dl) is harmful, and a reading below 54 is “cause for immediate action.”

Metformin, on the other hand, has been shown to have cardio-protective benefits along with decreasing blood glucose, says Gerald Bernstein, MD, an endocrinologist and the coordinator of the Friedman Diabetes Program at Lenox Hill Hospital in New York City, who also wasn’t involved in the study. “Metformin is also beneficial for weight loss and lipid control,” he says. (Lipids are mainly fatty acids and

Does Metformin Cause Weight Loss? What to Know Before You Take It

Sulfonylureas Are Still Used as an Alternative Medication for Type 2 Diabetes

Because of the potential harmful side effects of sulfonylureas, Dr. Bernstein has not prescribed these drugs for almost 20 years. Both Bernstein and Courgi say that endocrinologists prefer alternatives, but the primary-care community often relies on these medications.

“The reality is primary-care physicians in the community rely on sulfonylureas because they are inexpensive and easy to use [taken in pill form], and the doctors have a familiarity with them,” says Courgi.

As alternative second-line therapies, the AACE recommends drugs known as

“With so many alternatives, I think sulfonylureas are not warranted except for very short-term use,” says Bernstein.

Sarah Samaan, MD, a cardiologist with Baylor Regional Medical Center in Plano, Texas, who treats many patients with type 2 diabetes who have heart and vascular disease, recommends asking your doctor about your options. “Based on these results,” she says, “I would advise that anyone who is taking a sulfonylurea without metformin have a discussion with their physician to see if there are other medications that can be considered.”

Semaglutide May Control Blood Sugar in Diabetes Better Than Other Medications

How This Study Builds on Previous Research Involving Sulfonylureas

Suissa points out that the safety of sulfonylureas with respect to harmful cardiovascular and hypoglycemic events has been studied extensively in the past.

“Most of these studies assessed the safety of sulfonylureas either when used as first-line treatment, which is a less-common scenario [than] their use as second-line treatment, or as second-line treatment in comparison with other potential second-line treatments such as

,” he says. “Thus, only sparse data were available with respect to the risk of sulfonylureas as second-line treatments as compared with remaining on monotherapy with the first-line drug metformin.”

Suissa stresses that the study was limited by the “relatively short follow-up” of about one year, so further observational investigations are needed to assess long-term risks. Research comparing sulfonylureas to newer type 2 diabetes medications will also be helpful, he says.

, Dr. Samaan cautions that it can be difficult to be sure whether any person's heart attack was a consequence of the sulfonylurea therapy, or whether it would have happened regardless. “But since this study looked at such a large group of people [more than 77,000], it was able to show that there is indeed a statistically higher risk when the sulfonylurea drug is used without metformin,” she says.

Quitting Smoking Dramatically Reduces Diabetes-Related Heart Disease Risk, Study Suggests

Controlling that risk factor, as well as four others, reduces the risk for early death, heart attack, and stroke, to only 10 percent higher than the g...

Going Low-Carb for Type 2 Diabetes Management: Is Keto, Paleo, or Atkins Best?

Very-low-carb diets can help people with type 2 diabetes slash unwanted pounds and get their blood sugar under control. Learn what research suggests a... Hypoglycemia

Study Suggests How Weight Loss Can Reverse Type 2 Diabetes in Some People

Scientists have found that shedding pounds reduces fat in the liver and pancreas, returning blood sugar levels to normal for some.

Taking Sulfonylureas With or After Metformin May Raise Heart and Hypoglycemia Risks in People With Type 2 Diabetes

The study results support prior research on the potential harms of using sulfonylureas as a second-line treatment.

Why People With Type 2 Diabetes Need Dairy and the Best Sources to Help Manage Your Blood Sugar

You can have your Gouda and eat it, too, but there are a few things adults with diabetes should keep in mind.

12 Apps for Managing Diabetes: Blood Glucose Trackers, Food and Exercise Logs, and More

From food and exercise to everyday blood glucose management, there’s a lot to monitor when you have diabetes. These apps can help you stay on track.

Highlights From the 2018 ADA Scientific Sessions: Diabetes and Autism Link, Unaffordable Insulin, Artificial Pancreas Success, and More

The annual meeting takes place in Orlando, Florida, and this year, studies on diagnosis, treatment, and prevention all made headlines.

First Implantable Continuous Glucose Monitor Receives FDA Approval for Type 1 and Type 2 Diabetes

The Eversense Continuous Glucose Monitoring System can be used for 90 days with the same sensor. It’s the first fully implantable device approved by t...

A Single Blood Sample May Be Sufficient to Diagnose Diabetes

In a study, the test accurately predicted prediabetes and diabetes, and avoided false diabetes diagnoses as well.

A Diabetes Diagnosis After Age 50 May Be an Early Sign of Pancreatic Cancer in Black, Latino People

The findings may help doctors identify more people at risk for the potentially deadly cancer.

Pill May Help People With Type 2 Diabetes Lose Weight, Control Blood Sugar, Early Findings Suggest

The compound was tested in rodents and provides a temporary coating on the intestine before eating, but more research is needed before it’s known whet...

Type 2 Diabetes Drug Semaglutide May Help Control Blood Sugar Better Than Similar Medications, Review Suggests

In the review, semaglutide, which is sold under the brand name Ozempic, also helped people with type 2 diabetes lose weight and lower their blood pres...

How Learning to Manage Type 2 Diabetes Made One Couple’s Marriage Stronger

When Al Garcilazo was diagnosed with type 2 diabetes, his wife made it her mission to help him get healthy, and in the end, their bond became even str...

Lesbian and Bisexual Women May Have a Higher Risk of Type 2 Diabetes, Study Says

Compared with heterosexual women, those who identified as lesbian or bisexual had a 27 percent higher risk of developing type 2 diabetes.

Study Says Eggs Don’t Increase Heart Risk for People With Type 2 Diabetes

Researchers found that egg consumption did not contribute to cardiovascular risk factors so long as it was part of a healthy diet. Hypoglycemia

Should People Considered ‘Skinny Fat’ Be Screened for Diabetes?

Research suggests body fat percentage may be a better predictor of type 2 diabetes than BMI, the commonly used measurement for health risk.

Not Getting Enough Vitamin D May Increase Your Risk of Type 2 Diabetes, Study Finds

Though more research is needed, an observational study on about 900 healthy, mostly white older adults suggests that the more vitamin D you take in, t...

Eating Breakfast Later May Increase Your Obesity Risk if You Have Type 2 Diabetes

The small study found that night owls who preferred to eat breakfast later tended to have a higher BMI compared with people who went to sleep earlier ...

FDA Approves Marketing of Device That Can Help Detect Irreversible Diabetic Retinopathy

The device, called the IDx-DR, may help increase access to diagnostic tools for diabetes-related vision loss, but only if physicians decide to adopt i...

The Health Benefits and Risks of Green Tea for People With Type 2 Diabetes Hypoglycemia

Green tea doesn’t contain added sugar, is naturally calorie-free when enjoyed plain from the bag, and is a nutritional powerhouse — all of which makes...

© 1996-2018 Ziff Davis, LLC. Everyday Health is among the federally registered trademarks of Ziff Davis, © 1996-2018 Ziff Davis Hypoglycemia

This site complies with the HONcode standard for trustworthy health information: