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Type 2 diabetes increases the risk of cardiovascular disease (CVD) and reducing this disease burden through glycaemic control has long been the principal objective of treating the disease. No treatment has yet succeeded in reaching this objective. There are concerns that sulfonylurea (SU) medications may increase, rather than decrease this risk.SUs have been central to the management of type 2 diabetes for many decades. Every month, more than 600 000 prescriptions for SUs are dispensed in England and current National Institute for Health and Care Excellence (NICE) guidelines recommend them for second-line use after metformin. The American College of Endocrinologists downgraded this role for SUs in 2009 and the European Association for the Study of Diabetes (EASD) did likewise in 2012.There are three major concerns regarding SUs. Firstly their widely acknowledged and indisputable tendency to cause hypoglycaemia.Second is the belief that they accelerate beta pancreatic cell failure. This was demonstrated by their marked lack of durability in maintaining glycaemic control in the UK Prospective Diabetes Study (UKPDS) and ADOPT (A Diabetes Outcome Progression Trial) study. This was highlighted by Ralph de Fronzo in his 2008 American Diabetes Association’s Banting lecture, in which he declared that: ‘Sulfonylureas are not recommended because, after an initial improvement in glycaemic control, they are associated with a progressive rise in HbA1c and progressive loss of beta cell function’. 1The third and most worrying concern regarding SUs relates to questions regarding their cardiovascular safety. These questions have remained unanswered for more than 40 years.The University Group …

Time to be cautious about prescribing sulfonylureas?