Sulfonylurea Use and Cardiovascular Safety Revisited

Sulfonylurea use has been commonplace for the management of type 2 diabetes as an adjunct to metformin over the past decades. Their effectiveness has been repeatedly demonstrated in terms of glycemic control in the short-term however, long-term sustainable control remains in question. Over the years, FDA mandated cardiovascular safety trials have been completed involving most newer antidiabetic therapies to the market place however, the sulfonylurea class had not been studied until the recent head-to-head cardiovascular outcomes trial involving the comparison of linagliptin, an inhibitor of DPP-IV, with glimepiride in the CARMELINA study where non-inferiority was demonstrated in both treatment groups. While this finding seems to be reassuring, does it really confer safety of use of sulfonylurea drugs in the management of type 2 diabetes?