Sulfonylureas for Type 2 Diabetes: Whether to Add or to Switch

Metformin, a first-line drug for patients with type 2 diabetes, is associated with low risk for adverse cardiovascular events and hypoglycemia; whereas sulfonylureas, which are second-line drugs, are associated with excess cardiovascular and hypoglycemic risks. Yet, sulfonylureas are the second most–commonly prescribed drugs for initial treatment of patients with type 2 diabetes and are the most-commonly prescribed combination regimen with metformin. In this observational study, investigators used a U.K. primary care database to assess risks associated with adding a sulfonylurea to metformin or switching from metformin to sulfonylurea monotherapy.

Of 77,000 patients (age, >40) with type 2 diabetes who initiated metformin monotherapy from 199…