Metformin vs Sulfonylurea: Hyperglycemia Treatment in Older Adults

This report examines the effectiveness of metformin versus sulfonylurea in treating hyperglycemia, focusing on a cohort study involving US veterans aged 65 and older. The study, published in Neurology, investigates the potential association of these medications with the risk of dementia. The analysis reveals that while metformin use was linked to a lower risk of dementia in patients under 75, sulfonylurea showed a higher risk in patients over 75. The report highlights the study's methodology, including the use of national databases to identify medication usage and the exclusion of patients with renal dysfunction or those on insulin therapy. The author also critiques the original article for lacking a comprehensive literature review and failing to address ethical considerations. The report concludes by emphasizing the implications for nursing practices, suggesting that healthcare professionals consider these findings when prescribing medications for diabetic patients to mitigate the risk of dementia.

Running head: TREATMENT OF HYPERGLYCEMIA
TREATMENT OF HYPERGLYCEMIA
Name of the Student
Name of the University
Author note

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The clinical question- In patients of age above 65 years, is sulfonylurea more
effective than metformin?
Article- Orkaby, A. R., Cho, K., Cormack, J., Gagnon, D. R., & Driver, J. A.
(2017). Metformin vs sulfonylurea use and risk of dementia in US veterans
aged≥ 65 years with diabetes. Neurology, 89(18), 1877-1885.
The high blood sugar or hyperglycemia effects mostly the persons who are already suffering
from diabetes mellitus. There are several factors which lead to the occurrence of hyperglycemia
including the food that the patient is taking, the physical activities of the patients, other illness,
the medications or skipping the medications and not taking the medicines for lowering the
glucose levels of the patient (Thorpe, et al., 2015). I have found this article after doing lots of
researches on the disease hyperglycemia by considering different conditions of the disease, like
the current status of the disease, the rate of people suffering from diabetes, the side effects of the
medicines that are used to treat diabetes and also the other commodities associated with diabetes
(Kowall, Rathmann & Kostev, 2015). I have found so many diseases associated with diabetes.
Because of regular intake of the anti-diabetic medicines the risk of occurring of other diseases
also increases. Sulfonylurea and metformin are the medicines which are mostly used for treating
diabetes, the effectiveness of these two medicines are different and also chances of occurring of
other diseases are also increased (Lu et al., 2018). I have searched different databases for finding
papers but I got this paper from PubMed.
I got different papers must I have not used the other papers as the information provided in
all those articles were not much relevant to the developed research question. I found this article

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to be the relevant one. Before finding this article I have reviewed the literature behind this topic.
The keywords that were used for doing the literature review are hyperglycemia, medicine
metformin, sulfonylurea and old people. The article that I have chosen is Orkaby, A. R., Cho, K.,
Cormack, J., Gagnon, D. R., & Driver, J. A. (2017). Metformin vs sulfonylurea use and risk of
dementia in US veterans aged≥ 65 years with diabetes. Neurology, 89(18), 1877-1885. This
paper is discussing about the side effects of the drugs metformin and sulfonylurea. These two
drugs are the most potential medicines of diabetes and this paper discusses by which medicine is
more potential in causing dementia to a diabetic patient. The objective of this paper is to
determine whether metformin or sulfonylurea is more effective to incidences of dementia to the
patients suffering from hyperglycemia. The study is a cohort study which involves the US
veterans and who are above 65 years of age. All of the patients that were involved in the
experiment were suffering hyperglycemia but none of them were suffering from dementia which
is a major comorbid disease of type II diabetes. The patients were kept under the medications of
both the medicines. 17200 diabetic patients were kept under the medication of metformin and
11400 diabetic patients were kept under the medicine sulfonylurea. The mean age of the patients
was 73.5 years and the mean HbA1C was 6.8%. The follow up was done after 2 years of the
completion of therapy. After the average follow up of 5 years, diagnosis of 4906 cases were
done. For the patients less than 75 years of age the crude hazard ratio of metformin and
sulfonylurea was 0.67 and of the patients above 75 years the crude hazard ratio was 0.78. Lower
risk of dementia was also found to the diabetic young veterans and had the renal functions were
also good.
The study design of this experiment is a cohort study. In the methodology, the diabetes
medications were found using the National Veteran Administration clinical and Administrative

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databases were included to find which medications will be appropriate for pursuing the
experiment. It was ensured that all the patients who are involved in the experiment are able to
take only one oral medications were not. Only the patients who were remaining on the single
diabetes therapy after two years of the first prescription were used for doing the experiment. Also
the patients who were suffering from renal dysfunction were also excluded from participating in
the experiment. Regarding the use of the diabetes medicines, at least two outpatient prescriptions
in between the baseline and time of the beginning of the follow up, was included. The patients
who started their course of medications through insulin were excluded from participating in the
experiment as the comparison would not be much efficient with the oral medicines. The primary
outcome was the diagnoses of any dementia, the secondary outcomes included the AD and
vascular dementia. The dementia was defined by using ICD-9 codes. The definition of the
covariates were done by differentiating through the ICD-9 codes. To identify the utilization of
healthcare, the drug classes were encountered.
As already mentioned the participant were all suffering from diabetes and all of them
were above 65 years of age. There was also an expected outcome regarding the variance of the
dementia in the diabetic patient. The patient can suffer from primary dementia or secondary
dementia. The prognostic factors were also taken into consideration, the medications of the
patients before the starting of the follow up was also studied and by taking into consideration of
these the participants were chosen. The result showed that the association in between the intake
of metformin and the risk of dementia was attenuated but was not significant in the results
obtained from those above 75 years of age but not in the case of the patients whose age was less
than or equal to 75 years of age. The results were almost same and was thus not much
significant.

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From this discussing this paper it can be said that the use of sulfonylurea is more
associated with the higher risk of dementia than the use of metformin in patients suffering from
high hyperglycemia in the veterans above 75 years of age. The use of metformin was associated
with a lower risk of 11% than sulfonylurea in the patients less than 75 years of age but no
difference was there in patients above 75 years of age.
The evidences or data that are collected from this experiment is not likely to cause any
bias. The study design of this experiment is cohort study, so no chances of biases are there (Prinz
et al., 2016). Normally bias occur in the systematic studies where the data collection method is
completely dependent on the researches done before and the data are collected from those
research papers only (van Dalem et al., 2016). But in this experiment original study was done
involving huge number of participants. The result obtained from each and every patient were
recorded and thus no two results can be same. Results of two persons cannot be same. No such
adverse conditions happened during the whole experiment. To avoid the occurrence of any
adverse conditions the people who were treated with insulin were avoided, only the patients
treated by oral medicines were involved.
The article has started doing the experiment by reviewing the literature behind this. The
authors proceeded with the experiment by keeping in mind and applying all the knowledge as
described in the previous research papers but nothing such is mentioned in the background or the
literature review. So a huge literature gap is present in the research paper. Though the paper is
not a systematic review, but the authors would have mentioned about the previous literatures
about this topic (Zhou et al., 2015). Nothing was mentioned about whether any research was
done in the past in relation to the occurrences of the dementia in the diabetic patients (Chin et al.,
2016). Even the medicines that are used to treat diabetes, the side effects of the diseases are also

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not mentioned. It seems like the authors have studied nothing about these topics. It would be
easier for the readers to compare this article with the evidences from previous works (Wang et
al., 2017).
In this article the authors have not mentioned nothing about any ethical issues but any
issue could have happened if any of the participants could not have maintained the
confidentiality of the whole experiment. It is completely unethical to tell other people about the
experiment in which they are involved. Other issue would have happened if the health conditions
of the patients get deteriorated after the application of the medicines (Inzucchi et al., 2015).
This evidence undoubtedly can be implemented in the nursing practices. Dementia is a
global disease. People throughout the world are suffering from dementia so this disease needs to
be reduced. The diabetic patient deliberately take the medicines metformin and sulfonylurea as
prescribed by the doctors but this needs to be reduced (Campbell et al., 2017). If the diabetic
patient goes on consuming the medicines then in future the diabetic patients will also acquire
severe dementia. So the doctors can check the status of the diabetic patient and then prescribe
medicines. Even the nurses can also apply the theory that the chances of occurring of dementia is
lower in diabetic patients who are taking metformin than those who are taking sulfonylurea
(Anabtawi & Miles, 2016).

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References
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