Estimating the effect of sulfonylurea on HbA in diabetes: A systematic review and meta-analysis

Journal article

Aims/hypothesis: Sulfonylureas are widely prescribed glucose-lowering medications for diabetes, but the extent to which they improve glycaemia is poorly documented. This systematic review evaluates how sulfonylurea treatment affects glycaemic control. Methods: Medline, EMBASE, the Cochrane Library and clinical trials registries were searched to identify double-blinded randomised controlled trials of fixed-dose sulfonylurea monotherapy or sulfonylurea added on to other glucose-lowering treatments. The primary outcome assessed was change in HbA, and secondary outcomes were adverse events, insulin dose and change in body weight. Results: Thirty-one trials with a median duration of 16 weeks were included in the meta-analysis. Sulfonylurea monotherapy (nine trials) lowered HbA by 1.51% (17 mmol/mol) more than placebo (95% CI, 1.25, 1.78). Sulfonylureas added to oral diabetes treatment (four trials) lowered HbA by 1.62% (18 mmol/mol; 95% CI 1.0, 2.24) compared with the other treatment, and sulfonylurea added to insulin (17 trials) lowered HbA by 0.46% (6 mmol/mol; 95% CI 0.24, 0.69) and lowered insulin dose. Higher sulfonylurea doses did not reduce HbA more than lower doses. Sulfonylurea treatment resulted in more hypoglycaemic events (RR 2.41, 95% CI 1.41, 4.10) but did not significantly affect the number of other adverse events. Trial length, sulfonylurea type and duration of diabetes contributed to heterogeneity. Conclusions/interpretation: Sulfonylurea monotherapy lowered HbA level more than previously reported, and we found no evidence that increasing sulfonylurea doses resulted in lower HbA. HbA is a surrogate endpoint, and we were unable to examine long-term endpoints in these predominately short-term trials, but sulfonylureas appear to be associated with an increased risk of hypoglycaemic events. © 2013 The Author(s).

Authors: Hirst, J; Farmer, A; Stevens, R; Dyar, A; Lung, T

• Journal: Diabetologia
• Volume: 56
• Issue: 5
• Pages: 973-984
• Publication date: 2013-05-01
• DOI: 10.1007/s00125-013-2856-6
• EISSN: 1432-0428
• ISSN: 0012-186X