Positioning sulfonylureas in a modern treatment algorithm for patients with type 2 diabetes: expert opinion from a European Consensus Panel

The large number of pharmacological agents available to treat type 2 diabetes (T2D) makes choosing the optimal drug for any given patient a complex task. Since newer agents offer several advantages, whether and when sulfonylureas (SUs) should still be used to treat T2D is controversial. Published treatment guidelines and recommendations should govern the general approach to diabetes management. However, expert opinions can aid in better understanding local practices and in formulating individual choices. The present consensus paper aims to provide additional guidance on the use of sulfonylureas in T2D. We summarize current local treatment guidelines in European countries, showing that SUs are still widely proposed as second line treatment after metformin and often ranked at the same level as newer glucose-lowering medications. Strong evidence now shows that SGLT2-i and GLP-1RAs are associated with low hypoglycemia risk, promote weight loss, and exert a positive impact on vascular, cardiac, and renal endpoints. Thus, using SUs in place of SGLT2-i and GLP-1RAs may deprive patients of key advantages and potentially important cardiorenal benefits. In subjects with ascertained cardiovascular disease or at very high cardiovascular risk, SGLT2-i and/or GLP-1RAs should be used as part of diabetes management, in the absence of contraindications. Routine utilization of SUs as second line agents continues to be acceptable in resource-constrained settings. This article is protected by copyright. All rights reserved.