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Clinical Summary

Combining Sulphonylureas and Beta-Blockers Increases Severe Hypoglycaemia Risk


  • In patients with type 2 diabetes (T2D), the concomitant use of sulphonylureas and beta-blockers was associated with an increased risk of severe hypoglycaemia compared with the use of sulphonylureas alone.
  • Cardioselectivity of beta-blockers did not modify this association.

Why This Matters

  • Patients with T2D and hypertension or heart failure should exercise caution when using sulphonylureas and beta-blockers concurrently and consider the use of alternative antidiabetic or cardiovascular drugs, especially if the baseline risk of hypoglycaemia is elevated.

Study Design

  • This retrospective cohort study included 252,869 patients with T2D who initiated a second-generation sulphonylurea between 1998 and 2020, identified using data from the UK Clinical Practice Research Datalink linked to the Hospital Episode Statistics and Office for National Statistics databases.
  • Funding: A Project Grant from the Canadian Institutes of Health Research.

Key Results

  • During a median follow-up of 7.9 years, 16,857 severe hypoglycaemic events were reported, with a corresponding crude incidence rate of 7.8 per 1000 person-years.
  • The concomitant use of sulphonylureas and beta-blockers vs the use of sulphonylureas alone was associated with a higher risk of severe hypoglycaemia (adjusted HR [aHR] 1.53; 95% CI 1.42 to 1.65).
  • The risk of severe hypoglycaemia did not differ by beta-blockers cardioselectivity (aHR 0.95; 95% CI 0.74 to 1.24).


  • Retrospective design.
  • Risk of residual confounding.