Tainan, Taiwan—While sulfonylurea use in the U.S. has declined significantly from 39.9% in 1999–2002 to 24.5% currently, more than a one-fourth of adults with diabetes who are aged older than 65 years and a lower percentage of those aged younger than 65 years are prescribed drugs in that class, almost all of them second-generation, according to a 2023 study.

That is why new research from Taiwan has raised concerns. National Cheng Kung University–led investigators undertook a study to examine the relationship between duration of medication use and prevalence of impaired awareness of hypoglycemia (IAH) among patients with insulin-treated or sulfonylurea-treated type 2 diabetes in Taiwan.

In the report in Annals of Family Medicine, the focus was on 898 patients (41.0% insulin users, 65.1% sulfonylurea users). The participants had a mean age of 59.9 years and were 50.7% female; they were enrolled in pharmacies, clinics, and health bureaus of Tainan City.

IAH was identified using Chinese versions of the Gold questionnaire (Gold-TW) and Clarke questionnaire (Clarke-TW). The researchers also collected sociodemographics, disease and treatment histories, diabetes-related medical care, and health status information.

The results indicated that overall, IAH prevalence was 41.0% (Gold-TW) and 28.2% (Clarke-TW) among insulin users and 65.3% (Gold-TW) and 51.3% (Clarke-TW) among sulfonylurea users.

“Prevalence increased with the duration of sulfonylurea use, whereas it decreased with the duration of insulin use,” the authors pointed out. “After controlling for potential confounders, 5 or more years of sulfonylurea use was significantly associated with 3.50-fold (95% CI, 2.39-5.13) and 3.06-fold (95% CI, 2.11-4.44) increases in the odds of IAH based on the Gold-TW and Clarke-TW criteria, respectively. On the other hand, regular blood glucose testing and retinal examinations were associated with reduced odds in both insulin users and sulfonylurea users.”

The study team advised that while the prevalence of IAH was high among patients using sulfonylureas long term, “…the odds of this complication were attenuated for those who received regular diabetes-related medical care. Our study suggests that long-term sulfonylurea use, and irregular follow-up increase the risk for IAH. Further prospective studies are needed to confirm the observed associations.”

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