Two widely prescribed drugs for type 2 diabetes—sulfonylureas and basal insulin—may increase the risk of severe cardiovascular problems such as heart attacks, strokes, heart failure, and amputations, according to a recent study by researchers at Northwestern University.
These findings highlight the need for caution when selecting treatments beyond the first-line medication for type 2 diabetes.
The Role of Second-Line Diabetes Drugs
For most patients, the first treatment for type 2 diabetes is metformin, a drug that helps control blood sugar. However, when metformin doesn’t work well enough or causes side effects, doctors often turn to other medications.
Among the most commonly chosen are sulfonylureas and basal insulin. Together, these drugs are prescribed to over 60% of patients nationwide requiring a second-line treatment.
The study, published in JAMA Network Open, analyzed data from 132,737 patients with type 2 diabetes who started a second-line therapy. It aimed to compare the heart-related outcomes of the six major second-line diabetes medications.
Alarming Findings on Cardiovascular Risks
The researchers discovered that sulfonylureas and basal insulin were associated with significantly higher risks of cardiovascular events compared to newer medications like DPP-4 inhibitors.
Patients taking sulfonylureas faced a 36% increased risk of events like heart attacks and strokes. The risks were even greater for those on basal insulin, doubling their likelihood of cardiovascular harm.
For every 37 patients treated with basal insulin over two years, one would experience a serious cardiovascular event. For sulfonylureas, this number was 103 patients.
When applied to the millions of Americans living with diabetes, these numbers translate into potentially widespread harm.
Implications for Diabetes Treatment
The study’s authors, led by Matthew O’Brien, are calling for a reevaluation of how second-line diabetes medications are prescribed.
They suggest that doctors consider newer classes of drugs, such as GLP-1 agonists (e.g., liraglutide), SGLT-2 inhibitors (e.g., empagliflozin), or DPP-4 inhibitors (e.g., sitagliptin).
These newer drugs have shown a lower risk of cardiovascular problems and additional health benefits. However, they are significantly more expensive than sulfonylureas, a key reason why the older drugs remain widely used.
Balancing Costs and Patient Safety
While cost is a critical factor in healthcare decisions, this study emphasizes that patients and doctors must weigh the potential long-term risks of cheaper medications against their immediate affordability.
Patients should be informed of the potential cardiovascular dangers associated with sulfonylureas and basal insulin, particularly if they have existing heart disease or other risk factors.
The study also highlights the importance of real-world data in understanding drug safety.
While randomized clinical trials often compare new drugs to placebos, this observational study evaluated outcomes among patients using commonly prescribed medications, providing insights into how these drugs perform in everyday settings.
Toward a Paradigm Shift
The findings suggest a need for a significant change in how type 2 diabetes is managed.
Newer medications might be more expensive upfront, but they could reduce the long-term burden of complications like heart attacks and strokes, ultimately improving patient outcomes and potentially lowering overall healthcare costs.
For now, patients and physicians must work together to choose treatments that balance efficacy, safety, and affordability. Meanwhile, further research and policy changes could help make safer, newer drugs more accessible to those who need them most.
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 health, please see recent studies that blueberries strongly benefit people with metabolic syndrome, and results showing eggs in a plant-based diet may benefit people with type 2 diabetes.
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