title: The hypoglycemic risk of glyburide (glibenclamide) compared with modified-release gliclazide.
abstract: OBJECTIVE
  The risk for hypoglycemia when taking glyburide compared with modified-release gliclazide remains to be established in older adults in routine care. We investigated the risk of a hospital encounter with hypoglycemia following a new prescription for glyburide compared with modified-release gliclazide.
  
  
  METHODS
  In 2 population-based matched retrospective cohort studies in Ontario, Canada, between 2002 and 2011, we examined older adults who were newly prescribed glyburide or gliclazide as monotherapy or in the presence of metformin. Our primary outcome was a hospital encounter with hypoglycemia assessed within 90 days.
  
  
  RESULTS
  The baseline characteristics between matched groups were similar. Initiating glyburide vs. gliclazide as monotherapy was associated with a higher risk for a hospital encounter with hypoglycemia (69 patients of 4374 taking glyburide [1.58%] vs. 8 patients of 4374 taking gliclazide [0.18%], absolute risk increase 1.40% [95% CI 1.01% to 1.79%], number needed to harm 71 [55 to 99], odds ratio 8.63 [95% CI 4.15 to 17.93], p<0.0001). Similar findings were noted when glyburide vs. gliclazide was initiated in the presence of metformin (110 patients of 8038 taking glyburide [1.37%] vs. 19 patients of 8038 taking gliclazide [0.24%], absolute risk increase 1.13% [95% CI 0.86% to 1.40%], number needed to harm 77 [71 to 116], odds ratio 6.06 [95% CI 3.68 to 9.97], p<0.0001).
  
  
  CONCLUSIONS
  Glyburide was associated with a higher risk for hypoglycemia than modified-release gliclazide. The results of our studies may help to convince healthcare professionals who use glyburide to consider modified-release gliclazide as a safer alternative.
authors.affiliation: Department of Medicine, Western University, London, Ontario Canada. Electronic address: kclemens2008@meds.uwo.ca.
authors.forename: Kristin K
authors.initials: KK
authors.lastname: Clemens
authors.affiliation: Institute for Clinical Evaluative Sciences, London, Ontario Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: McArthur
authors.affiliation: Institute for Clinical Evaluative Sciences, London, Ontario Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario Canada.
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: Dixon
authors.affiliation: Institute for Clinical Evaluative Sciences, London, Ontario Canada; Division of Nephrology, Department of Medicine, Western University, London, Ontario Canada.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Fleet
authors.affiliation: Division of Endocrinology, Department of Medicine, Western University, London, Ontario Canada.
authors.forename: Irene
authors.initials: I
authors.lastname: Hramiak
authors.affiliation: Institute for Clinical Evaluative Sciences, London, Ontario Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario Canada; Division of Nephrology, Department of Medicine, Western University, London, Ontario Canada.
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
keywords: diabetes; diabète; elderly; gliclazide; glyburide; hypoglycemia; hypoglycémie; personnes âgées