ArticleJournal of the American Geriatrics Society2026
Glycemic Control and Utilization Risk With the Conversion of Glimepiride to Glipizide in Adults 64 Years and Older at an Integrated Health Care System.
Article in Journal of the American Geriatrics Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundShort-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.
methodsWe 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.
resultsOf 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.
conclusionPatients 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.
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