Which drug class in the BEERS criteria is known to cause hypoglycemia, particularly the sulfonylureas ending with -ide?

• A. Beta blockers
• B. Diuretics
• C. Antipsychotics
• D. Sulfonylureas

Answer: (D)

Sulfonylureas are the drug class flagged in the BEERS criteria for causing hypoglycemia in older adults. They work by stimulating pancreatic beta cells to release insulin, which can lower blood sugar regardless of food intake. This risk is especially pronounced in the elderly due to irregular meals, renal impairment, polypharmacy, and reduced counterregulatory responses. Within this class, those ending with -ide (such as glyburide) tend to have longer duration of action or active metabolites that linger in the body, increasing the chance and duration of hypoglycemia. If a sulfonylurea is used, the safer approach is to prefer the short-acting option with careful dosing and monitoring, or consider alternative therapies, to minimize hypoglycemia risk.