Drug-induced hypoglycaemia in type 2 diabetes

Abstract

Introduction: Hypoglycaemia is a side effect caused by some therapies for type 2 diabetes, which can cause physical, social and psychological harm. Hypoglycaemia also prevents attainment of treatment goals and satisfactory glycaemic control.

Areas covered: The risk of hypoglycaemia associated with commonly prescribed therapies, including metformin, sulphonylureas, dipeptidyl peptidase-4 enzyme (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) agonists and thiazolidinediones, is reviewed in this paper (insulin-induced hypoglycaemia is not included). Other medications that are frequently co-prescribed in type 2 diabetes are also discussed, including anti-hypertensive drugs, antibiotics and fibrates, along with various important patient-related risk factors.

Expert opinion: Hypoglycaemia is a common and potentially dangerous side effect of some medications used for type 2 diabetes. The risk of hypoglycaemia should always be considered when selecting and implementing a therapy, with a focus on the individual. Future research into new therapies should measure the frequency of hypoglycaemia prospectively and accurately. Hypoglycaemia has been shown to be a potentially life-threatening metabolic stress; therefore therapies that effectively manage diabetes without the risk of hypoglycaemia are likely to be favoured in the future.

Keywords::

• DPP-4 inhibitor
• GLP-1 agonist
• hypoglycaemia
• metformin
• sulphonylurea
• thiazolidinedione
• Type 2 diabetes

Declaration of interest

B M Frier has served on advisory boards for Eli Lilly, Novo Nordisk, MSD, Boehringer Ingelheim, Bristol-Myers Squibb, AstraZeneca and Johnson & Johnson, and has received honoraria as a speaker at scientific meetings sponsored by Eli Lilly, Nov Nordisk, Boehringer Ingelheim and Sanofi Aventis. All other authors declare no conflict of interest.

Notes

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