In elderly people with type 2 diabetes, sulphonylureas should be used with caution because the risk of hypoglycemia increases exponentially with age [Grade D, Level 4 (80) ].
In general, initial doses of sulphonylureas in the elderly should be half of those used for younger people, and doses should be increased more slowly [Grade D, Consensus].
Gliclazide and gliclazide MR [Grade B, Level 2 (85,87) ] and glimepiride [Grade C, Level 3 (86) ] should be used instead of glyburide, as they are associated with a reduced frequency of hypoglycemic events.
Meglitinides may be used instead of glyburide to reduce the risk of hypoglycemia [Grade C Level 2 (92) for repaglinide; Grade C, Level 3 (93) for nateglinide], particularly in patients with irregular eating habits [Grade D Consensus].