Recent research by scientists from Northwestern University has raised concerns about the safety of two common drugs prescribed for type 2 diabetes.
These drugs, sulfonylureas and basal insulin, have been associated with a higher risk of heart attack, stroke, heart failure, or amputation in diabetes patients.
When Metformin Isn’t Enough
Sulfonylureas and basal insulin are typically prescribed when metformin, a widely accepted initial treatment for type 2 diabetes, either proves ineffective or is not well-tolerated by the patient.
They are commonly used as secondary medications to help manage blood sugar levels.
This study is the first to comprehensively compare the impact of six major second-line diabetes drugs on heart-related outcomes in type 2 diabetes patients who require additional medication beyond metformin.
The Findings
The research revealed that patients taking sulfonylureas were 36 percent more likely to experience cardiovascular harm, such as heart attacks, strokes, heart failure, or amputations, compared to those taking a newer class of diabetes drugs called DPP-4 inhibitors.
For those on basal insulin, the risk was even higher, with a twofold increase in cardiovascular harm.
The study’s implications are significant, as one of these two drugs is prescribed to approximately 60 percent of patients who require a second-line diabetes medication.
When applied to the estimated 30 million Americans with diabetes, these findings underscore the potential harm these medications may be causing to a substantial number of patients.
Considering Alternatives
The research team suggests that healthcare providers 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 resorting to sulfonylureas or basal insulin.
These newer drugs have demonstrated better safety profiles in terms of cardiovascular outcomes.
One of the reasons sulfonylureas and basal insulin remain popular choices is their lower cost compared to the newer alternatives.
This cost factor often influences treatment decisions, and the research highlights the need to weigh potential cardiovascular risks against economic considerations.
The study utilized real-world evidence from a substantial sample of 132,737 patients with type 2 diabetes starting second-line treatment.
This approach complements findings from previous randomized trials, which typically compared one active drug to a placebo.
The research underscores the importance of patients being informed about the potential cardiovascular risks associated with their diabetes medications.
It calls for a shift in the paradigm of type 2 diabetes treatment, emphasizing the need to prioritize the cardiovascular health of patients.
The study, conducted by Matthew O’Brien and colleagues, was published in JAMA Network Open, prompting a reevaluation of diabetes medication choices and a renewed focus on patient safety.
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