Introduction and Objective: Sulfonylureas (SU), commonly used for type 2 diabetes, are metabolized by liver cytochrome P450 2C9 (CYP 2C9), which is inhibited by amiodarone. Given their frequent co-administration in patients with diabetes and arrhythmia, we evaluated the risk of severe hypoglycemia associated with their concomitant use.Methods: Using South Korean health insurance claims data (2010-2022), we identified cohorts of adult patients with type 2 diabetes aged ≥18 years. These patients initiated antiarrhythmic drugs, either amiodarone or other antiarrhythmics (flecainide, sotalol, and propafenone), while on SU. The risk of severe hypoglycemia was evaluated using hazard ratios (HR) with 95% confidence intervals (CI). Propensity-score matching weights were applied to ensure balance between groups.Results: Among 26,611 patients, 20,756 (78.0%) initiated amiodarone (mean age 71.3 years, 61% male), and 5,855 (22.0%) initiated other antiarrhythmics (mean age 68.7 years, 56% male). The weighted HR for severe hypoglycemia associated with amiodarone was 1.68 (95% CI 1.14-2.48). This increased risk remained consistent across various sensitivity analyses.Conclusion: Initiation of amiodarone while on sulfonylureas was associated with an increased risk of hypoglycemia, warranting attention and monitoring when sulfonylureas and amiodarone are used concomitantly.
S. Bea: None. H. Lee: None. K. Bykov: None. J. Shin: None.
American Diabetes Association (1-25-PDF-66); National Institutes of Health (K01AG068365)
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