Type 2 Diabetes Diagnosis & Treatment Sulfonylureas: Brand Comparison for Type 2 Diabetes When to consider sulfonylureas over metformin or vice versa By Angelica Bottaro Angelica Bottaro Facebook LinkedIn Angelica Bottaro is a writer with expertise in many facets of health including chronic disease, Lyme disease, nutrition as medicine, and supplementation. Learn about our editorial process Published on November 22, 2022 Medically reviewed by Danielle Weiss, MD Medically reviewed by Danielle Weiss, MD LinkedIn Dr. Danielle Weiss is the founder of the Center for Hormonal Health and Well-Being, a personalized, proactive, patient-centered medical practice with a unique focus on integrative endocrinology. She enjoys giving lectures and writing articles for both the lay public and medical audiences. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Effects on Type 2 Diabetes Sulfonylureas vs. Metformin Brand-Name and Generic Types Potential Side Effects Drug Interactions Frequently Asked Questions Sulfonylureas are a class of medications used to manage type 2 diabetes. The drugs work by encouraging the release of insulin from the pancreas to help lower blood sugar levels. This article discusses everything you need to know about how sulfonylureas work for type 2 diabetes and what to expect when taking the drug. Courtney Hale / Getty Images Effect of Sulfonylureas on Type 2 Diabetes People with type 2 diabetes must manage their blood sugar levels because their bodies do not respond to insulin. As a result, sugar levels build up in the blood and cause health issues. Sulfonylureas stabilize blood sugar by helping the pancreas create more insulin. Sulfonylureas stimulate pancreatic β-cells, the cells in the pancreas that produce and release insulin. Increased insulin levels in the body improve the transfer of blood sugar into cells. Sulfonylureas also reduce the amount of insulin cleared from the body by the liver, which prevents high blood sugar. Can People With Type 1 Diabetes Take Sulfonylureas? In people with type 1 diabetes, the body does not produce insulin. Because of that, sulfonylureas can only be used for those with type 2 diabetes. How Hyperglycemia Is Treated Sulfonylureas vs. Metformin Metformin is another drug that treats diabetes. It works similarly to sulfonylureas by helping the body handle insulin more appropriately. However, Metformin belongs to a different class of medicines known as biguanides. Biguanides work by increasing how well insulin works as opposed to keeping more insulin in the body. Although both drugs treat type 2 diabetes, Metformin is often the first-choice therapy and is a better choice for people with health complications such as reduced kidney function. In some cases, the two drugs will be taken in a combinational approach to help better control diabetes and blood sugar levels. The safety level of both medications depends highly on a person’s health history, any complications or health issues they have outside of type 2 diabetes, and their healthcare provider’s recommendations. That said, some research has found that taking sulfonylureas can increase the risk of cardiovascular complications over metformin use. How to Choose Your healthcare provider will provide a medication recommendation based on their knowledge of your current state of health. Brand-Name and Generic Types Many different medications fall under the umbrella of sulfonylureas. Brand Name and Generic Types of Sulfonylureas Generic Name Brand Name Glimepiride Amaryl Glipizide GlipiZIDE XL, Glucotrol, Glucotrol XL Glyburide Micronase, Glynase PresTab, Glynase, Glycron, DiaBeta Potential Side Effects Though sulfonylureas are well-tolerated by many, some known side effects can develop when taking the drug. Those side effects can include: Hypoglycemia (dangerously low blood sugar) A worsening insulin response Weight gain Nausea Feeling full in the upper abdomen Heartburn Light-colored stools Pain in the upper-right area of the stomach Unusual bleeding or bruising Diarrhea Sore throat Swelling of the eyes, face, lips, tongue, or throat Skin reactions that mimic allergies Sensitivity to the sun Severe skin inflammation that covers the entire body An impaired liver function could lead to jaundice, hepatitis, and liver failure Changes in how the heart functions An increased risk of heart disease and stroke Hypoglycemia and Sulfonylureas Hypoglycemia occurs when blood sugar levels become dangerously low. In people taking sulfonylureas, too much insulin can build up in the body and cause low blood sugar levels. People can experience a fast heartbeat, nervousness or anxiety, irritability or confusion, and dizziness when this happens. In the most severe cases, coma, brain damage, and death can occur from hypoglycemia. Drug Interactions Some medications should not be taken at the same time as sulfonylureas or hold a higher risk for adverse effects, such as: Aspirin Medications that reduce blood pressure, such as beta-blockers Clarithromycin, an antibiotic Colesevelam, a cholesterol-lowering drug Antifungal medications Non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil Quinolone antibiotics Sulfamethoxazole, an antibiotic Topiramate, an anti-seizure medication Warfarin, a blood thinner Medications, Supplements, and Sulfonylureas When you are about to begin taking sulfonylureas, be sure to tell your healthcare provider about all medications and supplements you take, whether they're prescribed or over the counter (OTC). It’s vital to ensure that you do not experience adverse effects because of drug interactions. Ask an Expert: What Are Barriers to Type 2 Diabetes Treatment? Summary Sulfonylureas are a class of type 2 diabetes drugs. They are considered safe and effective and stabilize blood sugar by increasing insulin production. Though sulfonylureas are effective, they are not always the first choice when treating type 2 diabetes. Typically, that is metformin. However, the drug given to you will depend highly on your health history and how you respond to medications. All medications have side effects. Some are more severe than others and require monitoring. If you experience side effects, it’s essential to contact your healthcare provider. They can determine if the medication is still suitable for you based on your experience, how well your blood sugar is managed, and what other drugs or supplements you are taking. A Word From Verywell Type 2 diabetes isn’t always easy to cope with, but it can be managed effectively with medications such as sulfonylureas. They are generally considered safe, so if your healthcare recommends them, it’s probably for a good reason. Managing diabetes early on will significantly reduce your risk of complications caused by untreated high blood sugar levels. If you are unsure about taking this drug, speak to your healthcare provider for more information about whether it's right for you. Frequently Asked Questions What’s considered the safest sulfonylurea? The majority of sulfonylureas are considered safe when taken correctly. However, some come with side effects and an increased risk of harmful complications. According to research, the best sulfonylurea is glimepiride. Learn More: List of Oral Diabetes Medications When should you consider metformin instead of sulfonylureas? Your current state of health and health history will play a role in which medication is chosen for managing type 2 diabetes. When choosing between metformin and sulfonylureas, many factors are in play. Typically, metformin is the preferred choice for people who are more at risk for hypoglycemia or those with chronic kidney disease. Learn More: Metformin Is Not Working: How to Tell and What to Do What are the risks of sulfonylureas in older adults? Many older adults may have to be wary of sulfonylureas for managing their type 2 diabetes. That is because the medication can increase the risk of hypoglycemia. Hypoglycemia can cause issues such as dizziness that may increase the risk of falls in older adults and the risk of harmful fractures. Learn More: Hypoglycemic Episode Symptoms, Complications, and More 11 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Sola D, Rossi L, Schianca GPC, Maffioli P, et al. Sulfonylureas and their use in clinical practice. Arch Med Sci. 2015 Aug 12;11(4):840-8. doi:10.5114/aoms.2015.53304 Medline Plus. Glyburide. Nasri H, Rafieian-Kopaei M. Metformin: current knowledge. J Res Med Sci. 2014 Jul;19(7):658-64. Roumie CL, Chipman J, Min JY, Hackstadt AJ, Hung AM, Greevy RA Jr, Grijalva CG, Elasy T, Griffin MR. Association of treatment with metformin vs sulfonylurea with major adverse cardiovascular events among patients with diabetes and reduced kidney function. JAMA. 2019 Sep 24;322(12):1167-1177. doi:10.1001/jama.2019.13206 Madsen KS, Kähler P, Kähler LK, et al. Metformin and sulphonylurea (second‐ or third‐generation) combination therapy for adults with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2016 Sep 26;2016(9):CD012368. doi:10.1002/14651858.CD012368 Douros A, Dell’Aniello S, Yu OHY, et al. Sulfonylureas as second-line drugs in type 2 diabetes and the risk of cardiovascular and hypoglycemic events: Population-based cohort. BMJ. 2018;362:k2693. doi:10.1136/bmjk2693. National Institute of Diabetes and Digestive and Kidney Diseases. Sulfonylureas, Second Generation. 2018. Nishihama K, Eguchi K, Maki K, et al. Sudden death associated with severe hypoglycemia in a diabetic patient during sensor-augmented pump therapy with the predictive low glucose management system. Am J Case Rep. 2021 Jan 19;22:e928090. doi:10.12659/AJCR.928090 Straight Healthcare. Sulfonylureas. Kalra S, Aamir AH, Raza A, et al. Place of sulfonylureas in the management of type 2 diabetes mellitus in South Asia: A consensus statement. Indian J Endocrinol Metab. 2015 Sep-Oct;19(5):577-96. doi:10.4103/2230-8210.163171 Lapane KL, Yang S, Brown MJ, et al. Sulfonylureas and risk of falls and fractures: A systematic review. Drugs Aging. 2013 Jul;30(7):527-47. doi:10.1007/s40266-013-0081-0 By Angelica Bottaro Angelica Bottaro is a professional freelance writer with over 5 years of experience. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Cookies Settings Accept All Cookies