If SGLT-2 inhibitors need to be added when sulfonylureas are used to treat type 2 diabetes, the dose can be appropriately reduced to reduce the risk of "hypoglycemia"

Hypoglycemia is a common adverse effect of antidiabetic drugs and is associated with an increased risk of cardiovascular disease and death

The risk of hypoglycemia is not clearly demonstrated when sodium-glucose co-transporter 2 (SGLT-2) inhibitors are used concomitantly with sulfonylureas

The researchers searched Medline, EMBASE, the Cochrane Central Register of Controlled Trials and Clinicaltrial.

Finally, 12 studies including 3761 participants were included, and corresponding systematic reviews and meta-analyses were performed

Risk of bias assessment of included studies

Subgroup analyses showed no difference between high-dose and low-dose SGLT-2 inhibitors

Forest plot of risk of hypoglycemia in patients treated with SGLT-2 inhibitors plus sulfonylureas versus placebo plus sulfonylureas

This systematic review and meta-analysis showed that when SGLT-2 inhibitors were added to sulfonylureas to treat patients with diabetes, the risk of hypoglycemia increased by more than 50%, and that this combination treatment resulted in less than One more case of hypoglycemia occurred in the first 6 months of treatment

SGLT-2 inhibitors increase glucose excretion to reduce hyperglycemia, a unique insulin-independent mode of action with limited risk of hyperglycemia

Therefore, the investigators suggest that the dose of sulfonylurea can be appropriately reduced when using full-dose SGLT-2 inhibitors

In conclusion, the addition of SGLT-2 inhibitors to sulfonylurea regimens in patients with type 2 diabetes may increase the risk of hypoglycemia

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