A study by scientists from Northwestern University has found that two drugs commonly prescribed for type 2 diabetes—sulfonylureas and basal insulin—carry a high risk of causing heart attacks, strokes, heart failure, or amputations.
The research is the first to compare how each of the six primary second-line drugs influences heart outcomes in patients with type 2 diabetes who require a second medication.
These two drugs are typically prescribed when metformin, a widely accepted initial treatment for type 2 diabetes, fails to work alone or isn’t tolerated.
Over half of patients (60%) nationwide who need a second-line drug receive one of these two medications.
However, the study found that patients taking either of these two drugs are more likely—36% more for sulfonylureas and twice as likely for basal insulin—to experience cardiovascular harm than those taking a newer class of diabetes drugs known as DPP-4 inhibitors.
The research suggests that doctors only need to prescribe basal insulin to 37 people over two years to observe one cardiovascular event, such as a heart attack, stroke, heart failure, or amputation.
For sulfonylureas, that number is higher—103 people. Applied to the 30 million Americans with diabetes, these figures suggest that these medications may be causing harm to a significant number of patients.
Implications and Future Directions
The researchers recommend that physicians 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 frequently after metformin, instead of sulfonylureas or basal insulin.
However, these drugs are more expensive than sulfonylureas, which is why they are not as commonly prescribed.
The study, which was observational and used data from 132,737 patients with Type 2 diabetes starting second-line treatment, calls for a paradigm shift in the treatment of Type 2 diabetes.
The team argues that people should be aware if their diabetes medications could lead to serious cardiovascular harm.
The research was published in JAMA Network Open and conducted by Matthew O’Brien et al.
If you care about diabetes, please read studies about new ways to achieve type 2 diabetes remission, and one avocado a day keeps diabetes at bay.
For more information about diabetes, please see recent studies about 5 dangerous signs you have a diabetes-related eye disease, and results showing why pomegranate is super fruit for people with diabetes.
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