Hypoglycemia risk is probably the most important limiting factor when attempting to treat to target diabetic subjects. Therefore, one needs always to consider how much a given treatment is likely to induce iatrogenic
hypoglycemia when choosing a therapeutic strategy for
type 2 diabetes. At present, a surprisingly scant amount of data is available about how frequent
hypoglycemia is relative to the use of a particular
drug. Furthermore, these data are not easy to interpret, having been collected in different ways and being often related to different ways of defining and detecting
hypoglycemia. The available literature does suggest, however, that
metformin and
thiazolidinedione treatments are associated with a negligible
hypoglycemia risk. On the other hand, sulphonylurea use (in particular
glybenclamide use) is associated with a frequency of
hypoglycemia far greater than commonly thought. Newer
therapies (like
incretin-based
therapies) are instead associated with a very low
hypoglycemia risk. With these agents, it appears that a significant
hypoglycemia risk is detected only when they are used as add-on
therapy to
insulin or sulphonylureas.