Glycemic Control and Utilization Risk With the Conversion of Glimepiride to Glipizide in Adults 64 Years and Older at an Integrated Health Care System

BACKGROUND: Short-acting sulfonylureas are preferred over long-acting sulfonylureas due to reduced risk of hypoglycemia in older adults. Whether older patients can be transitioned from long-acting to short-acting sulfonylureas with equivalent glycemic control while experiencing fewer emergency department (ED) visits or hospitalizations due to hypoglycemia is unknown. We investigated whether the conversion of long-acting glimepiride to short-acting glipizide led to equivalent glycemic control and whether it was associated with reduced ED or hospital utilization. METHODS: We conducted a retrospective-cohort study of 625 Kaiser Permanente Southern California members between ages 64 and 110 years old dispensed glimepiride between 03/15/2023 and 03/14/2024. The conversion to glipizide occurred at the dispensing pharmacy after the index date in March 2024. The co-primary outcomes were to determine whether glycemic control could be maintained with the conversion of one sulfonylurea to another based on a follow-up HgbA1c at 6 to 12-weeks post-conversion while reducing ED utilization or hospitalization for patients within 2 and 4-months of the index date. RESULTS: Of 625 patients eligible for the intervention, 472 converted to glipizide and 153 remained on glimepiride. Results 6 to 12-weeks post-index date showed no difference in HgbA1c between those who remained on glimepiride (mean = 7.8; SD = 1.3) and those who converted (mean = 7.8; SD = 1.1). For risk of ED or hospitalization from hypoglycemia, no significant difference was found within 2 months (OR: 0.68, 95% CI: 0.34, 1.36) after adjusting for age and comorbidities. Those who converted to glipizide had lower risk of ED or hospitalization within 4-months (OR: 0.49, 95% CI: 0.29, 0.85) than patients remaining on glimepiride. CONCLUSION: Patients 64 years and older converted from long-acting to short-acting sulfonylureas had no change in glycemic control, and lower rates of ED or hospital utilization at 4-months were observed. This paper reaffirms the Beers Criteria statement that shorter-acting sulfonylureas are preferred over longer-acting sulfonylureas.