Comparative safety of sulfonylurea therapies on cardiovascular and severe hypoglycemia outcomes among adults with type 2 diabetes and moderate cardiovascular risk: a target trial emulation
Authors' conclusion
Among adults with T2D and moderate cardiovascular risk, glimepiride was associated with lowest risk of MACE and glipizide with lowest risk of severe hypoglycemia. These results can help inform treatment selection if sulfonylureas are used for glucose-lowering.
Study context
- Population
- Adults ≥21 years with T2D and moderate cardiovascular risk initiating glimepiride, glipizide or glyburide 2014–2021; Optum Labs Data Warehouse and Medicare fee-for-service 100% sample; mean age 66.9 years, 52.0% menweighted cohort
- Participants
- 314,699 adults
- Exposure
- Glyburide and glipizide vs glimepiride
- Outcome
- Major adverse cardiovascular events (MACE)
Methodological detailsretrospective cohort study using claims data, inverse probability of treatment weighting, propensity scores estimated using super learner ensemble, inverse probability of treatment weighting (IPTW) Cox proportional hazards models
- Retrospective cohort study using claims data
- Inverse probability of treatment weighting
- Propensity scores estimated using super learner ensemble
- IPTW Cox proportional hazards models
Main finding
As reported in the abstract
Each group vs glimepirideHazard ratio (95% CI)
Glyburide
1.10(1.05–1.16)
Glipizide
1.05(1.03–1.07)
Observational data: associations, not effects.
Safety
| Outcome | Glimepiride | Glipizide | Glyburide | HR (95% CI) | |
|---|---|---|---|---|---|
| Severe hypoglycemia (ED or hospital encounters)Glyburidevs Glipizide | 0.3% | 0.3% | 0.4% | 1.43 (1.23–1.65) | |
| Severe hypoglycemia (ED or hospital encounters)Glipizidevs Glimepiride | 0.82 (0.77–0.87) | ||||
| 0.512Hazard ratio (log scale) |
- Severe hypoglycemia (ED or hospital encounters): per-group values at 1 year
Original publication
Comparative safety of sulfonylurea therapies on cardiovascular and severe hypoglycemia outcomes among adults with type 2 diabetes and moderate cardiovascular risk: a target trial emulation. BMJ Open Diabetes Res Care. Published 26 February 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →