In a recent study from Northwestern University, researchers found two drugs commonly prescribed to treat Type 2 diabetes carry a high risk of cardiovascular events, including heart attack, stroke, heart failure, or amputation.
The two drugs—sulfonylureas and basal insulin—are commonly prescribed when metformin, a widely accepted initial Type 2 diabetes treatment, doesn’t work alone or isn’t tolerated.
In the study, the team compared how each of the six major second-line drugs impacts cardiovascular outcomes in Type 2 diabetes patients taking second diabetes medication.
Basal insulin is engineered to release slowly over the course of the day, compared to faster-acting prandial insulin, which is taken before meals.
The team found one of these two drugs are prescribed to more than half of patients nationwide (60%) who need a second-line drug.
Yet, patients who take one of these two drugs are more likely—36% more for sulfonylureas and twice as likely for basal insulin—to experience heart harm than those taking a newer class of diabetes drugs known as DPP-4 inhibitors.
The team says physicians 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 sulfonylureas or basal insulin.
These drugs, however, are more expensive than sulfonylureas, which is the main reason they are not as commonly prescribed.
This should force providers to think about the heart effects of these drugs early in the course of diabetes treatment and shift prescribing patterns to newer drugs that have more favorable cardiovascular profiles.
This was an observational study using data from 132,737 patients with Type 2 diabetes who were starting second-line treatment.
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The study is published in JAMA Network Open. One author of the study is Matthew O’Brien.
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