Clinical Inquiries question: In patients with type 2 diabetes mellitus (T2DM), does the combination of insulin and sulfonylurea (SU) increase the risk of hypoglycemia? Evidence-based answer: The incidence of severe hypoglycemia in patients with T2DM taking insulin alone, SU alone, or the combination of insulin and SU is low (strength of recommendation [SOR] A based on a systematic review of randomized controlled trials). The combination of insulin and SU in patients with T2DM does increase the risk of hypoglycemia; however, the clinical significance of this risk is small (SOR B based on 4 large retrospective cohort studies). Of note, patients 65 years and older are at an increased risk of hypoglycemia compared with younger patients, although the clinical significance has not been specified (SOR B based on 2 large retrospective cohort studies).Karyn B. Kolman, MD; Joshua Freeman, MD; Carol L. Howe, MD, MLSDr Kolman is Assistant Professor and Dr Freeman is Clinical Professor in the Department of Family and Community Medicine at the University of Arizona in Tucson. Dr Howe is a librarian in the Health Sciences Library at the University of Arizona.Includes bibliographical reference
