Use of Sulfonylurea Drugs in Elderly Patients

Sulfonylureas are used widely to treat hyperglycemia in elderly non-insulin-dependent diabetes mellitus (NIDDM) patients. Because this patient population is growing rapidly, it is likely that use of these agents will continue to increase. There is a considerable knowledge base regarding the clinical pharmacology, mechanism of action, and adverse side effects of these agents and >30 yr of clinical experience with their use. However, there is little specific information about these drugs in patients >65 yr of age and virtually no information about use of these drugs in people >85 yr of age. The effectiveness of sulfonylureas to lower glucose levels, the simplicity of dosing regimens, and their relative safety are all advantages for their use in an elderly NIDDM population. Disadvantages of these agents include the relatively low likelihood of achieving euglycemia, the risk of hypoglycemia, and a number of negative interactions with other drugs. In common with all other modalities used to treat hyperglycemia, of most concern is the lack of established benefit of these drugs to reduce the risk of long-term complications of diabetes mellitus. There is clearly a need for more information about the benefits and risks of the use of sulfonylureas in an elderly diabetic patient population.