The effect of sulphonylureas on the microvascular and macrovascular complications of diabetes

Cardiovasc Drugs Ther. 2008 Jun;22(3):207-13. doi: 10.1007/s10557-008-6090-2. Epub 2008 Feb 21.


Introduction: Type 2 diabetes mellitus is a chronic progressive disease that is characterised by hyperglycaemia and is associated with an increased risk of the development of microvascular complications, such as retinopathy, nephropathy and neuropathy, and cardiovascular disease. With the introduction of newer oral hypoglycaemic agents, there is a need to re-evaluate critically the effectiveness and safety of the older agents, including sulphonylureas, to assess their place in the modern management of type 2 diabetes.

Background: Though no clear benefit of sulphonylureas has been shown with respect to large vessel disease, long term studies have, however, shown benefits in patients with microvascular complications. Studies such as the University Group Diabetes Project raised concerns about the safety profile of sulphonylureas, but large prospective studies such as the UK Prospective Diabetes Study have helped to assuage such concerns to a large degree. Their utility in the peri-infarct period continues to be debatable because of the potential effect on cardiac pre-conditioning.

Conclusion: Though sulphonylureas continue to be a mainstay of treatment in type 2 diabetes, future clinical trials addressing clinically relevant outcomes are indicated with the newer generation of sulphonylureas that are more beta cell-specific to address the concerns raised about sulphonylureas and cardiac myocytes.

Publication types

  • Review

MeSH terms

  • Animals
  • Diabetic Angiopathies / pathology
  • Diabetic Angiopathies / prevention & control*
  • Humans
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use*
  • Microcirculation / drug effects*
  • Microcirculation / pathology
  • Sulfonylurea Compounds / adverse effects
  • Sulfonylurea Compounds / therapeutic use*


  • Hypoglycemic Agents
  • Sulfonylurea Compounds