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Sulfonylureas-associated cardiovascular disease and beta-cell dysfunction - is it time to dispel the myth?

Sulfonilureas, su asociación con Enfermedad Cardiovascular y disfunción de la célula beta. ¿Es tiempo de desaparecer el mito?

VOLUMEN 4 - NÚMERO 3 / Julio - Septiembre (Artículo de Revisión)


Rene Rodríguez-Gutiérrez, Servicio de Endocrinología, Departamento de Medicina Interna, Hospital Universitario `Dr. José E. González´, Monterrey, N.L., México; Department of Medicine, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
Paloma Almeda-Valdés, Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Ciudad de México, México
Rosario Arechavaleta-Granell, Clinical Investigation Area, Unidad de Patología Clínica. Guadalajara, Jal., Mexico
Rafael Campuzano-Rodríguez, Profesor de Endocrinología de la Universidad de Michoacán
Hugo Laviada-Molina, Universidad Marista de Mérida, Mérida, Yuc., México
Juan Rosas-Guzmán, Jefe de Endocrinología, Centro de Especialidades de Celaya, Celaya, Gto., México
Rafael M. Violante-Ortiz, Clinical Investigation Area, Unidad de Patología Clínica. Guadalajara, Jal., Mexico

The evidence regarding sulfonylureas glucose-lowering efficacy is robust; furthermore, they are convenient and their out-ofpocket cost is in the range of many other diabetes medications. Sulfonylureas can cause weight gain, and particularly if used inappropriately, hypoglycemia. Furthermore, some studies have related their use to adverse cardiovascular outcomes, including mortality. In addition, sulfonylurea-associated induced beta-cell dysfunction has been proposed as one of the most important disadvantages related to their use. On the other hand, hypoglycemia is related to death, cardiovascular events, myocardial infarction, stroke, cognitive impairment, dementia, impaired autonomic function, fall-related fractures, poor quality of life, and increased health-care costs. These adverse outcomes seem to be related more to episode(s) of hypoglycemia per se rather than to the use of sulfonylureas or a particular anti-hyperglycemic drug class. In addition, across studies, data associating sulfonylureas with adverse cardiovascular events, including death, remains imprecise, and inconsistent. Likewise, the pancreatic beta-cell function is modified by many factors, and its relation with sulfonylureas remains open to debate. Hence, when choosing a diabetes drug, patients and clinicians should discuss differences between
glucose-lowering medications in terms of benefits, harms, cost, and convenience. In this patient-centered discussion, sulfonylureas should be included as one of the evidence-based available options.

Palabras clave: Diabetes. Sulfonylurea. Hypoglycemia. Betacell dysfunction.

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