Converting older adults from glimepiride to glipizide maintained equivalent HgbA1c (7.8% vs 7.8%) and reduced the risk of ED or hospitalization at 4 months (OR 0.49; 95% CI 0.29-0.85).
Cohort (n=625)
Does the conversion of long-acting glimepiride to short-acting glipizide maintain glycemic control and reduce ED or hospital utilization in adults 64 years and older?
Converting older adults from glimepiride to glipizide maintains glycemic control while reducing short-term ED and hospital utilization, supporting Beers Criteria recommendations.
Effect estimate: OR 0.49 (95% CI 0.29-0.85)
Absolute Event Rate: 7.8% vs 7.8%
BACKGROUND: Short-acting sulfonylureas are preferred over long-acting sulfonylureas due to reduced risk of hypoglycemia in older adults. Whether older patients can be transitioned from long-acting to short-acting sulfonylureas with equivalent glycemic control while experiencing fewer emergency department (ED) visits or hospitalizations due to hypoglycemia is unknown. We investigated whether the conversion of long-acting glimepiride to short-acting glipizide led to equivalent glycemic control and whether it was associated with reduced ED or hospital utilization. METHODS: We conducted a retrospective-cohort study of 625 Kaiser Permanente Southern California members between ages 64 and 110 years old dispensed glimepiride between 03/15/2023 and 03/14/2024. The conversion to glipizide occurred at the dispensing pharmacy after the index date in March 2024. The co-primary outcomes were to determine whether glycemic control could be maintained with the conversion of one sulfonylurea to another based on a follow-up HgbA1c at 6 to 12-weeks post-conversion while reducing ED utilization or hospitalization for patients within 2 and 4-months of the index date. RESULTS: Of 625 patients eligible for the intervention, 472 converted to glipizide and 153 remained on glimepiride. Results 6 to 12-weeks post-index date showed no difference in HgbA1c between those who remained on glimepiride (mean = 7.8; SD = 1.3) and those who converted (mean = 7.8; SD = 1.1). For risk of ED or hospitalization from hypoglycemia, no significant difference was found within 2 months (OR: 0.68, 95% CI: 0.34, 1.36) after adjusting for age and comorbidities. Those who converted to glipizide had lower risk of ED or hospitalization within 4-months (OR: 0.49, 95% CI: 0.29, 0.85) than patients remaining on glimepiride. CONCLUSION: Patients 64 years and older converted from long-acting to short-acting sulfonylureas had no change in glycemic control, and lower rates of ED or hospital utilization at 4-months were observed. This paper reaffirms the Beers Criteria statement that shorter-acting sulfonylureas are preferred over longer-acting sulfonylureas.
Lee et al. (Thu,) conducted a cohort in Diabetes mellitus (n=625). Glipizide vs. Glimepiride was evaluated on HgbA1c at 6 to 12-weeks post-conversion and ED utilization or hospitalization within 2 and 4-months (OR 0.49, 95% CI 0.29-0.85). Converting older adults from glimepiride to glipizide maintained equivalent HgbA1c (7.8% vs 7.8%) and reduced the risk of ED or hospitalization at 4 months (OR 0.49; 95% CI 0.29-0.85).