Addition of sulphonylurea to metformin does not relevantly change body weight: a prospective observational cohort study (ZODIAC-39).
To investigate changes in body weight trajectories after the addition of individual sulphonylureas (SUs) to metformin in patients with type 2 diabetes.



We conducted a retrospective observational cohort study, in a primary care setting in the Netherlands. Patients aged ≥18 years with type 2 diabetes who were included in the ZODIAC cohort between 1998 and 2012 and who received metformin monotherapy at inclusion (n = 29 195), and had used metformin as monotherapy for at least 1 year before receiving dual therapy through the addition of an SU for at least 1 year were eligible for inclusion. The primary outcome was within-drug yearly change in body weight after receiving add-on therapy with individual SUs during 5 years of follow-up. The secondary outcome was within-drug yearly change in glycated haemoglobin (HbA1c). Annual changes in weight and HbA1c were estimated with linear mixed models, adjusted for age, gender and diabetes duration.



A total of 2958 patients were included. No significant weight changes were observed within and between any of the individual SUs after treatment intensification (p = 0.24). In addition, no significant difference in weight between the add-on therapy combinations was observed (p = 0.26). The average HbA1c the year before intensification was 7.2% (55 mmol/mol) and dropped below 7.0% (53 mmol/mol) the year after.



In patients with type 2 diabetes treated in primary care, strict glycaemic control can be maintained with SUs used as add-on therapy to metformin, without the offset of relevant weight changes.
Diabetes Centre, Isala, Zwolle, The Netherlands. d.schrijnders@isala.nl.
Dennis
D
Schrijnders
Diabetes Centre, Isala, Zwolle, The Netherlands.
Raiza
R
Wever
Diabetes Centre, Isala, Zwolle, The Netherlands.|Langerhans Medical Research Group, Zwolle, The Netherlands.|Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Nanne
N
Kleefstra
Diabetes Centre, Isala, Zwolle, The Netherlands.|Langerhans Medical Research Group, Zwolle, The Netherlands.|Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Sebastiaan T
ST
Houweling
Diabetes Centre, Isala, Zwolle, The Netherlands.|Langerhans Medical Research Group, Zwolle, The Netherlands.
Kornelis J J
KJ
van Hateren
Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Geertruida H
GH
de Bock
Diabetes Centre, Isala, Zwolle, The Netherlands.|Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.|Department of Internal Medicine, Isala, Zwolle, The Netherlands.
Henk J G
HJ
Bilo
Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Klaas H
KH
Groenier
Diabetes Centre, Isala, Zwolle, The Netherlands.|Langerhans Medical Research Group, Zwolle, The Netherlands.|Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands.
Gijs W D
GW
Landman
D000368:Aged; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D001835:Body Weight / Q000187:drug effects*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008297:Male; D008687:Metformin / Q000008:administration & dosage*; D008875:Middle Aged; D012189:Retrospective Studies; D013453:Sulfonylurea Compounds / Q000008:administration & dosage*
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008687:Metformin; D013453:Sulfonylurea Compounds
blood glucose; body weight; diabetes mellitus type 2; humans; metformin; prospective studies; sulphonylurea compounds