Positioning sulphonylureas in a modern treatment algorithm for patients with type 2 diabetes: Expert opinion from a European consensus panel

Agostino Consoli, Leszek Czupryniak, Rui Duarte, Gyorgy Jermendy, Alexandra Kautzky-Willer, Chantal Mathieu, Miguel Melo, Ofri Mosenzon, Frank Nobels, Nikolaos Papanas, Gabriela Roman, Oliver Schnell, Alexis Sotiropoulos, Coen D. A. Stehouwer, Cees J. Tack, Vincent Woo, Gian Paolo Fadini*, Itamar Raz

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review


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. Because newer agents offer several advantages, whether and when sulphonylureas (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 current consensus paper aims to provide additional guidance on the use of SUs 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 are often ranked at the same level as newer glucose-lowering medications. Strong evidence now shows that sodium-glucose co-transporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are associated with low hypoglycaemia risk, promote weight loss, and exert a positive impact on vascular, cardiac and renal endpoints. Thus, using SUs in place of SGLT-2is 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, SGLT-2is 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.

Original languageEnglish
Pages (from-to)1705-1713
Number of pages9
JournalDiabetes Obesity & Metabolism
Issue number10
Publication statusPublished - Oct 2020


  • antidiabetic drug
  • sulphonylureas
  • RISK


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