Het risico op hypoglykemieen bij sulfonylureum- derivaten ten opzichte van metformine in relatie tot nierfunctie en metabolietgroep

Risk of hypogiycaemia in users of sulphonylureas compared with metformin in relation to renal function andsulphonylurea metabolite group 08JECTIVE To determine whether treatment with sulphonylureas ISUs) only in patients with renal impairment is associated with a higher risk of hypogiycaemia compared to metformin-only users. DESIGN Retrospective population based cohort study. METHODS We conducted this study using data from the Clinical Practice Research Oatalink database (2004-2012). New users IN = 120,803] with at least one prescription for a non- insulin antidiabetic agent and aged over 18 were included. Associations between SU dose, renal impairment, different SUs used, and risk of hypogiycaemia were determined using Cox proportional hazard models. Adjustments were made for age. sex. life style, comorbidities and drug use. RESULTS The risk of hypogiycaemia in current SU-only users was significantly increased compared with current metformin- only users (adjusted hazard ratio (HRJ 2.50; 95[%] confidence interval (Cf95l 2.23-2.82). The risk in current SU-only users was further increased in patients with an EGFR <30 ImL/min)/ (1.73m?) (HRadj4.96: CI95 3.76-6.55). The risk of hypogiycaemia was also significantly higher in patients with a high SU dose (HRadj3.12; CI95 2.68-3.62) and with current glibenclamide use [[]HRadj7.48; CI95 4.89-11.44). Results for gliclazide. the currently recommend SU of first choice, showed a similar risk of hypogiycaemia compared to other SUs. SU treatment in patients with an EGFR <30 (mL/min)/ (1.73m2) should be considered with caution, especially the use of glibenclamide. In contrast with several guidelines, gliclazide does not seem to be superior to glimepiride, glipizide and tolbutamide.