SU's strengths maximized through combined use with SGLT-2is

...combined use eliminates disadvantages and maximizes advantages of the diabetes drug sulfonylurea

Professor Jin Hwa Kim of the Chosun University Hospital makes a theme presentation at the 2023 Fall Congress of the Korean Diabetes Association

"Misconception that SU drugs increase cardiovascular risk... Safer use in combination with SGLT-2"

"Concerns regarding hypoglycemia and weight gain are offset by combined use... can now use SU’s strong blood sugar lowering effect"

New opportunities have emerged for the use of the diabetes treatment sulfonylurea (SU).

 

It is claimed that its combined use with SGLT-2 inhibitor drugs can offset the existing disadvantages such as hypoglycemia and weight gain, while fully utilizing the strong blood sugar lowering effect of SU drugs.

 

Jin Hwa Kim, Professor, Department of Endocrinology and Metabolism, Chosun University Hospital

Professor Jin Hwa Kim of the Department of Endocrinology and Metabolism at Chosun University Hospital claimed so at the 2023 Spring Conference of the Korean Diabetes Association held at the Kimdaejung Convention Center in Gwangju on the 11th, where he made his theme presentation during the special session.

 

In his presentation on 'Expected Effects of Combined Use of Sulfonylurea and SGLT-2 Inhibitor in Type 2 Diabetes', he said, "The commonly known disadvantages and side effects of SU class drugs can be overcome by combining them with SGLT-2 inhibitor class drugs." "A recent study cleared the misconception that SU class drugs increase cardiovascular risk" SU-class antidiabetics were known to have clear advantages and disadvantages.

 

Although it has an excellent blood sugar lowering effect, its risk of hypoglycemia and weight gain were pointed out as disadvantages.

 

Also, there had been rising concerns about how it may increase the risk of cardiovascular disease.

 

Due to such reasons, the use of SU-class drugs had been gradually decreasing in practice.

 

In the past, other than metformin, SU was the most commonly used drug, but its prescriptions had decreased since the release of DPP-4 class drugs that have a lower risk of hypoglycemia.

 

However, Professor Jin Hwa Kim cleared the misconception that SU-class drugs have a high cardiovascular risk with a recent study.

 

According to Kim, the CAROLINA trial that was published in 2019 compared the cardiovascular safety of glimepiride, an SU drug, and linagliptin, a DPP-4 inhibitor.

 

Results of the CAROLINA trial, which studied 6,000 people in 43 countries around the globe for 8 years, showed that the cardiovascular safety of the two drugs was similar.

 

With glimepiride demonstrating safety similar to linagliptin, a drug proven to have cardiovascular safety, U-class drugs can be cleared of the misconception that it increases cardiovascular risk.

 

In the 'GRADE' study that compared glimepiride’s cardiovascular safety with liraglutide, a GLP-1 analog, results showed that glimepiride had a similar level of cardiovascular risk as liraglutide.

 

In addition, in another meta-study that compared SU class drugs with DPP-4 inhibitor class drugs or TZD class drugs, there was no significant difference in cardiovascular events and mortality between different classes overall.

 

With such research results coming out one after another, Professor Kim explained that the American Diabetes Association (ADA) issued a 'neutral' opinion on the cardiovascular risk of SU-class drugs in its diabetes treatment guidelines this year.

 

Professor Kim said, "The studies reduced overall concerns about cardiovascular risk.

 

Also, when used in combination with SGLT-2 inhibitors, which have cardiovascular benefits, its use will become much safer." "The risk of hypoglycemia and weight gain of SU class drugs can be offset by SGLT-2 inhibitors" Professor Kim claimed that the risk of hypoglycemia and weight gain, which were pointed out as other disadvantages of SU class drugs, can be sufficiently offset by combining the use of SGLT-2 inhibitor class drugs.

 

According to Kim, a recent meta-analysis showed that the risk of hypoglycemia increased when SU-class drugs were used in combination with SGLT-2 inhibitors.

 

On this, Professor Kim said, "However, specifics showed that results differed depending on the dosage of the SU class drugs.

 

When using SU drugs with SGLT-2 inhibitors, you can reduce the dose of the SU drug to reduce the risk of hypoglycemia.” Regarding the weight gain side effect, he added “There are concerns that SU drugs may cause weight gain, but it can be offset with SGLT-2 inhibitors.” Professor Kim added, “The concerns held by SU class drugs can be offset by combining its use with SGLT-2 inhibitors.

 

This will allow patients to fully enjoy the strong blood sugar lowering effect of SU class drugs.” Kang-Seo Park, professor of Endocrinology at Eulji University Hospital, who chaired the session, added, “For patients with high blood sugar, SU class drugs can be used to help lower blood sugar safely through combined use with SGLT-2 inhibitors.”