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Sulfonylurea hypoglycaemia — DGM MCQ

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HardPolypharmacySulfonylurea hypoglycaemiaDGM

An 83-year-old woman has recurrent symptomatic hypoglycaemia, including one collapse. She has type 2 diabetes, eGFR 42 mL/min/1.73 m2 and HbA1c 44 mmol/mol. Her medicines are gliclazide, metformin, ramipril, atorvastatin and aspirin. Which medication should be reviewed?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Gliclazide

A sulfonylurea such as gliclazide can cause hypoglycaemia, particularly when glycaemic targets are tight in an older person with comorbidity. Metformin is less likely to cause hypoglycaemia on its own. Diabetes treatment in frailty should prioritise avoidance of hypoglycaemia over tight numerical control.

Reference: BNF; NICE NG28; STOPP/START criteria v3