The addition of DPP-4 inhibitors to sulphonylureas in people with type 2 diabetes is associated with a 50% increased risk of hypoglycaemia, new research has revealed.

While the link is not new, this systematic review and meta-analysis, published in the British Medical Journal is the first to measure the magnitude of the risk.

“This meta-analysis found about a 50% increase in the risk of hypoglycaemia associated with the addition of DPP-4 inhibitors to sulphonylureas in people with type 2 diabetes,” the authors concluded.

“This adverse event, commonly experienced by people treated for diabetes, would lead to the occurrence of one excess case of hypoglycaemia in every 17 treated patients treated for six months. This potentially represents a huge number of attributable cases worldwide.”

Hypoglycaemia is a leading complication of T2D in adults aged over 60 years with a long history of the disease and is a major cause of hospitalisation for all people with T2D. Even when not directly life threatening, it is associated with an increased risk of all-cause mortality, cardiovascular disease, cardiovascular mortality, as well as hospital admission.

“These results clearly highlight the need to respect existing recommendations for dose reduction of sulphonylureas when initiating treatment with DPP-4 inhibitors, and the urgency to determine the efficacy of this measure in minimising the risk of hypoglycaemia,” the authors added.

Australian Diabetes Society President, Associate Professor  Sof Andrikopoulos said that while most specialists and diabetes educators would be well-aware of the link between hypoglycaemia and DPP-4 and sulphonylurea combination, but it was a timely reminder and also useful for general practitioners to be aware of.

“I think the message is, if you’re going to use it (DPP-4) with sulphonylurea, you need to be mindful of hypoglycaemia events,” he told the limbic.

He said the use of these drugs together had become more commonplace in Australia since they were listed on the PBS and subsidised for triple therapy with metformin.

Professor Andrikopoulos advocated a careful approach to managing dosages when using the drugs in combination, remembering that all patients are different and could take a couple of months to stabilise on the regime that is most effective for them.