In what patient population are sulfonylureas generally not recommended?

Sulfonylureas are a class of medications used primarily to treat Type 2 diabetes by stimulating insulin secretion from the pancreatic beta cells. Their use is not appropriate for patients with Type 1 diabetes due to the underlying pathophysiology of the disease. In Type 1 diabetes, the pancreas produces little to no insulin because of autoimmune destruction of the insulin-producing beta cells. Since sulfonylureas rely on functioning beta cells to stimulate insulin release, they would be ineffective in this population, as they cannot compensate for the absolute insulin deficiency found in Type 1 diabetes.

In contrast, sulfonylureas can be effective in managing blood glucose levels in individuals with Type 2 diabetes, where insulin secretion may still occur but is insufficient due to insulin resistance. Additionally, their use does not directly correlate with obesity or hypertension, as patients with these conditions may still have a functional beta cell reserve typical of Type 2 diabetes. Therefore, the recommendation against sulfonylureas is specifically tied to their ineffectiveness in patients with Type 1 diabetes.