In recent years, the number of people with type 2 diabetes has been steadily increasing, making it a significant public health concern.
Type 2 diabetes is characterized by high levels of glucose in the blood because the body cannot properly use insulin, the hormone that regulates blood sugar levels.
The first line of treatment for type 2 diabetes is usually the drug metformin. However, if metformin alone does not adequately control blood sugar levels, patients may need additional medications.
Two commonly prescribed second-line medications are sulfonylureas and basal insulin.
A recent study by scientists at Northwestern University has found that these two drugs carry a high risk of cardiovascular harm, including heart attacks, strokes, heart failure, and amputations.
This study is the first to compare the cardiovascular effects of the six major second-line drugs in patients with type 2 diabetes who need a second diabetes medication.
The researchers discovered that patients taking sulfonylureas or basal insulin were more likely to experience cardiovascular harm compared to those taking a newer class of diabetes drugs called DPP-4 inhibitors. Specifically, the risk was 36% higher for sulfonylureas and twice as high for basal insulin.
Based on these findings, the researchers recommend that physicians consider prescribing newer classes of antidiabetic medications, such as GLP-1 agonists, SGLT-2 inhibitors, or DPP-4 inhibitors, more often after metformin, rather than sulfonylureas or basal insulin.
Although the study’s findings are concerning, it is important to note that the research was observational and analyzed data from 132,737 patients with type 2 diabetes starting second-line treatment.
The scientists used real-world evidence, which complements findings from previous randomized trials that only compared one active drug to a placebo.
The study did not examine whether sulfonylureas and basal insulin might still be beneficial for some patients or how these drugs compare to newer medications in terms of controlling blood sugar levels.
However, the findings raise concerns about the safety of sulfonylureas and basal insulin, which are prescribed to more than half of patients nationwide who need a second-line drug.
The implications of these findings are significant when considering the 30 million Americans with diabetes.
The study found that prescribing basal insulin to just 37 people over two years could result in one cardiovascular event, such as a heart attack, stroke, heart failure, or amputation. For sulfonylureas, the number was slightly higher, at 103 people.
This study suggests that people with type 2 diabetes should be aware of the potential cardiovascular risks associated with their medications.
It calls for a paradigm shift in the treatment of type 2 diabetes, advocating for the more routine use of newer classes of antidiabetic medications, such as GLP-1 agonists, SGLT-2 inhibitors, or DPP-4 inhibitors, after metformin.
While these newer drugs may be more expensive than sulfonylureas, the cost savings from avoiding hospitalizations and other cardiovascular events could potentially outweigh the costs of the medications.
Preventing cardiovascular harm is not only about improving quality of life but also about saving lives. The study by Northwestern University, led by Matthew O’Brien and published in JAMA Network Open, highlights the need for careful consideration of medication choices in managing type 2 diabetes to minimize the risk of serious cardiovascular events.
If you care about heart health, it’s also beneficial to stay informed about the best times to take vitamins to prevent heart disease, and be aware of studies suggesting that flu and COVID vaccines may increase heart disease risk.
For further information, you can explore recent studies on how to lower heart disease risk if you have diabetes, and stories about individuals who have faced heart-related health issues.
If you care about diabetes, please read studies that pomace olive oil could help lower blood cholesterol, and honey could help control blood sugar.
For more information about diabetes, please see recent studies about Vitamin D that may reduce dangerous complications in diabetes and results showing plant-based protein foods may help reverse type 2 diabetes.
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