A Prospective Trial of Risk Factors for Sulfonylurea-Induced Hypoglycemia in Type 2 Diabetes Mellitus

CONTEXT.— Retrospective studies have identified oral sulfonylureas, age, and fasting as major risk factors for hypoglycemia in patients with type 2 diabetes. Sulfonylureas may be withheld from elderly patients out of concern for hypoglycemia. OBJECTIVE.— To evaluate the hypoglycemic effects of maximum doses of once-daily second-generation sulfonylureas administered to fasting elderly patients. DESIGN.— A prospective, randomized, double-blind clinical trial. SETTING.— The University of New Mexico General Clinical Research Center. PATIENTS.— Fifty-two sulfonylurea-treated subjects with type 2 diabetes with a mean (SD) age of 65.1 (5.7) years. INTERVENTIONS.— Subjects were randomly assigned to glyburide or glipizide gastrointestinal therapeutic system (GITS). Each subject participated in three 23-hour fasting studies after the sequential administration of 1 week of placebo and 1 week of 10 mg and 1 week of 20 mg of the assigned sulfonylurea. MAIN OUTCOME MEASURES.— Occurrence of hypoglycemia (defined as plasma glucose level