For decades, sulfonylureas and basal insulin have been two of the most commonly prescribed second-line drugs for treating type 2 diabetes when first-line treatment with metformin is ineffective or not well-tolerated.
But a groundbreaking study from Northwestern University is making medical professionals rethink this practice.
A Red Flag: The Cardiovascular Risk
The study is the first of its kind to scrutinize how these six primary second-line drugs affect heart health in type 2 diabetes patients requiring additional medication.
And the findings are concerning: patients on sulfonylureas have a 36% higher risk, and those on basal insulin have twice the risk of experiencing cardiovascular events compared to patients taking a newer class of diabetes medications known as DPP-4 inhibitors.
To put these figures into context, it means that for every 37 people prescribed basal insulin for two years, one will likely suffer a cardiovascular event like a heart attack or stroke.
For sulfonylureas, the corresponding number is 103 people. With 30 million Americans suffering from diabetes, the magnitude of this risk is enormous.
The Research’s Implications
These results necessitate an urgent reevaluation of current prescription guidelines.
The study suggests that newer classes of antidiabetic medications—such as GLP-1 agonists, SGLT-2 inhibitors, or DPP-4 inhibitors—may be more cardiovascular-friendly options for second-line treatment after metformin.
However, cost remains a key barrier. These newer medications are more expensive than sulfonylureas, explaining why they aren’t as widely prescribed.
The Bigger Picture
This study is a wake-up call for the medical community and patients alike.
While it was observational and used a large data set from 132,737 patients starting second-line treatment for type 2 diabetes, its findings call for a paradigm shift in how we approach diabetes treatment to minimize cardiovascular risk.
What Comes Next?
While it’s crucial for physicians to consider these new findings when prescribing medications, the high cost of newer medications must also be addressed.
Policymakers and healthcare providers need to work on making these safer but more expensive medications accessible for all, to avoid causing harm to a significant number of patients.
The research, led by Matthew O’Brien and published in JAMA Network Open, is a strong advocacy piece for patient safety and necessitates immediate action.
People should not have to choose between managing their blood sugar levels and risking severe cardiovascular events. It’s time for change.
If you care about heart health, please read studies about the best time to take vitamins to prevent heart disease, and scientists find how COVID-19 damages the heart.
For more information about heart health, please see recent studies about Aspirin linked to higher risk of heart failure, and results showing this drug could reduce heart disease, fatty liver, obesity.
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