Scientists from Northwestern University found two drugs commonly prescribed to treat Type 2 diabetes carry a high risk of cardiovascular events, including heart attack, stroke, heart failure, or amputation.
The two drugs—sulfonylureas and basal insulin—are commonly prescribed when metformin, a widely accepted initial Type 2 diabetes treatment, doesn’t work alone or isn’t tolerated.
The research is published in JAMA Network Open and was conducted by Matthew O’Brien et al.
The study is the first to compare how each of the six major second-line drugs impacts heart outcomes in Type 2 diabetes patients taking second diabetes medication.
One of these two drugs is prescribed to more than half of patients nationwide (60 percent) who need a second-line drug.
But the team found patients who take one of these two drugs are more likely—36 percent more for sulfonylureas and twice as likely for basal insulin—to experience cardiovascular harm than those taking a newer class of diabetes drugs known as DPP-4 inhibitors.
According to our findings, doctors only have to prescribe basal insulin to 37 people over two years to observe one cardiovascular event, such as a heart attack, stroke, heart failure, or amputation
For sulfonylureas, that number was a bit higher—103 people. But when these numbers are applied to 30 million Americans with diabetes, this has staggering implications for how it may be harming many patients.
The team says physicians should consider prescribing newer classes of antidiabetic medications, such as GLP-1 agonists (e.g., liraglutide), SGLT-2 inhibitors (e.g., empagliflozin), or DPP-4 inhibitors (e.g., sitagliptin), more routinely after metformin, rather than sulfonylureas or basal insulin.
These drugs, however, are more expensive than sulfonylureas, which is the main reason they are not as commonly prescribed.
This was an observational study using data from 132,737 patients with Type 2 diabetes who were starting second-line treatment.
The scientists used real-world evidence that complements findings from previous randomized trials which studied only one active drug compared to a placebo.
The team suggests that people should know if the medications they’re taking to treat their diabetes could lead to serious cardiovascular harm.
This calls for a paradigm shift in the treatment of Type 2 diabetes.
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