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Metformin and the sulphonylureas: the comparative risk

I W Campbell

    Hormone and Metabolic Research. Supplement Series
    |January 1, 1985
    PubMed

    Insights

    Sulfonylureas and metformin carry similar mortality risks in diabetes patients. Both drugs require careful use, especially in elderly individuals or those with kidney or liver issues.

    Area of Science:

    • Pharmacology
    • Internal Medicine
    • Clinical Toxicology

    Background:

    • Sulfonylurea-induced hypoglycemia (SIH) and metformin-associated lactic acidosis (MALA) are significant adverse drug events.
    • Previous literature indicated high mortality rates for MALA.

    Purpose of the Study:

    • To compare the mortality risks of SIH and MALA.
    • To evaluate the safety profiles of sulfonylureas and metformin in non-insulin-dependent diabetics.

    Main Methods:

    • Literature review of SIH cases until December 1982.
    • Analysis of MALA cases, including contraindications and drug overdosage.
    • Comparative mortality risk analysis using data from the Swedish Adverse Drug Reactions Advisory Committee (SADRAC).

    Main Results:

    • 843 SIH cases (9% mortality) and 42 MALA cases (43% mortality) were identified.
    • Most MALA cases had contraindications (e.g., renal impairment) or were due to overdose.
    • No significant difference in mortality risk was found between MALA and glibenclamide-associated hypoglycemia (0.0240 vs. 0.0332 per 1,000 patient-years).
    • Hypoglycemia incidence with glibenclamide was higher than lactic acidosis with metformin.

    Conclusions:

    • Sulfonylureas are not inherently safer than metformin.
    • Both drug classes demand cautious prescription for non-insulin-dependent diabetics.
    • Particular care is advised for elderly patients and those with renal or hepatic dysfunction.

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