Sulfonylureas in type 2 diabetes mellitus: current evidence, conflicts and clinical implications

Abstract

Introduction: We sought to explore the current state of evidence on sulfonylurea therapy in type 2 diabetes mellitus (T2DM) and critically examine the recommendations of major practice guidelines,and the overall ramifications of the issues thereof in current clinical practice.

Method: We searched PUBMED, MEDLINE and other databases, and selected, analysed and interpreted relevant original studies,reports and reviews on the subject.

Results: A compelling body of literature exist on the sulfonylurea use in T2DM, with a remarkable number of studies illuminating substantial clinical issues associated with their use. Nevertheless, definitive evidence is still limited in terms of unequivocally clarifying some of the concerns. All major practice guidelines mirrored a historical trend of consistent endorsement of sulfonylureas as first or second line agents in T2DM management. However, based on re-evaluation of available evidence, some latest guidelines have reflected a significantly declined confidence in the traditional status accorded to sulfonylureas in T2DM management, conspicuously contrasting other existing guidelines.

Conclusion: The apparent inconsistencies and deficiencies in the available body of evidence and the conflicting recommendations in current guidelines have raised new questions and complicated clinical considerations, creating a novel dilemma in the clinical use of sulfonylureas.

Keywords: Sulfonylurea; type 2 diabetes mellitus; evidence;guidelines; clinical practice