A recent study from Northwestern University has raised concerns about two widely used drugs for treating type 2 diabetes, sulfonylureas and basal insulin.
These drugs are commonly prescribed when metformin, the initial standard treatment, is either not enough or not suitable for a patient.
The study, a first of its kind, compared six major second-line diabetes medications to see their effects on heart health in patients who need additional treatment.
The analysis included data from 132,737 patients with type 2 diabetes beginning second-line treatment.
What the study uncovered is alarming: over half of the patients nationwide (60%) who require a second-line drug are prescribed either sulfonylureas or basal insulin.
However, these drugs were linked to a significantly higher risk of cardiovascular issues, such as heart attacks, strokes, heart failure, or amputation, compared to those taking DPP-4 inhibitors, a newer class of diabetes drugs.
The numbers are striking. The risk of cardiovascular harm increased by 36% for those taking sulfonylureas and doubled for basal insulin users.
This means that for every 37 people taking basal insulin over two years, one is likely to experience a cardiovascular event. For sulfonylureas, the number is 103 people.
Considering that 30 million Americans have diabetes, the potential for harm is substantial. This has led the research team to recommend a shift in treatment practices.
They advise physicians to consider prescribing newer classes of antidiabetic medications, such as GLP-1 agonists (like liraglutide), SGLT-2 inhibitors (like empagliflozin), or DPP-4 inhibitors (like sitagliptin) after metformin, rather than sulfonylureas or basal insulin.
However, a major hurdle is the cost. These newer drugs are more expensive, which is why they’re not as commonly prescribed as sulfonylureas.
This study highlights an important issue for patients with type 2 diabetes: the drugs they are taking to manage their condition could pose serious risks to their heart health.
It underscores the need for both patients and doctors to be aware of these risks and consider safer alternatives when possible.
The study, conducted by Matthew O’Brien and his team, is particularly significant as it uses real-world evidence.
This approach complements findings from previous trials that typically compare one active drug to a placebo, offering a broader perspective on the impact of these medications.
The research findings are published in JAMA Network Open and advocate for a change in how type 2 diabetes is treated, prioritizing patient safety and heart health.
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