Do Beta Cells Burn Out?
I’ve read that continued use of sulfonylureas leads to depletion of pancreatic beta cells. But I’ve also read that this was outdated information. What is the real story? Chandran Cheriyan, Saratoga, California
Craig Williams, PharmD, responds
Sulfonylurea drugs help control blood glucose by making beta cells produce more insulin. There is a long-standing debate as to whether or not that interaction may be harmful to the beta cells over time.
What to Know
Beta cells are the pancreatic cells that make insulin. In people with type 2 diabetes, it is common in the early years of the disease to secrete more insulin in response to insulin resistance. As diabetes progresses, beta cells can begin to burn out, eventually leading to worsening blood glucose control. While the loss of beta cells in type 1 diabetes is primarily due to autoimmune destruction, the process is poorly understood in type 2.
It’s long been observed that sulfonylurea drugs do not work as well for as long as some other oral medications do. While one explanation could be that sulfonylureas cause beta cells to die off faster than other diabetes medications do, the evidence to support this is far from convincing. In fact, it is more likely that continual stimulation from the medications causes certain cellular pathways—those that allow sulfonylureas to work—to stop functioning as well over time. Eventually this may render beta cells less able to respond to high blood glucose even though they are still very much alive.
While this may mean that other oral diabetes medications become better options for some people over time, we shouldn’t be afraid of starting and continuing sulfonylureas in people with diabetes. In 2012, the American Diabetes Association issued an update to its recommendations on the appropriate use of drugs to help control high blood glucose. Sulfonylureas remained one of the five core classes of medications recommended by the ADA as an add-on to metformin.
If blood glucose control is slowly worsening on any oral diabetes medication, do not be afraid to work with your health care provider to try different medications or combinations of medications to see what works best for you.
The effect of any medication for type 2 diabetes may wane over time, particularly for sulfonylureas. But their long-term track record for safety, how well they work, and their affordability make them a good choice for many people with type 2 diabetes.