Type 2 diabetes is one of the most common long-term health conditions in the world.
It affects hundreds of millions of people and increases the risk of serious complications, including heart disease, stroke, kidney disease, vision problems, and nerve damage.
Managing blood sugar levels is an important part of treatment, but researchers are increasingly recognizing that the choice of diabetes medication may also have a major impact on a person’s overall health.
A study from Northwestern University has raised concerns about two widely used diabetes medications. Researchers found that these drugs may increase the risk of serious heart-related complications compared with several newer treatment options.
For most people with type 2 diabetes, the first medication prescribed is metformin. Metformin has been used for decades and is generally considered safe, effective, and affordable.
However, many patients eventually need additional medications because metformin alone is not enough to control blood sugar levels. Others cannot take metformin because of side effects or certain medical conditions.
When this happens, doctors often prescribe a second-line treatment. There are several different types of diabetes medications available, each working in a different way to help lower blood sugar.
The Northwestern University researchers wanted to understand how these second-line medications affect heart health. They analyzed medical records from more than 132,000 people with type 2 diabetes who had started one of six commonly prescribed second-line treatments.
The study focused on serious cardiovascular events, including heart attacks, strokes, heart failure, and amputations. These complications are especially important because heart disease remains the leading cause of death among people with diabetes.
The findings revealed that around 60% of patients in the study were taking either sulfonylureas or basal insulin. These medications have been used for many years and are often chosen because they are relatively inexpensive compared with newer diabetes drugs.
However, the results showed that both medications were linked to a significantly higher risk of serious cardiovascular problems.
The researchers compared these drugs with a class of medications known as DPP-4 inhibitors. DPP-4 inhibitors are newer diabetes treatments designed to help the body regulate blood sugar more effectively.
Patients taking sulfonylureas had a 36% higher risk of experiencing a major cardiovascular event compared with those taking DPP-4 inhibitors. The findings were even more concerning for people taking basal insulin. Their risk of serious cardiovascular complications was approximately twice as high as that of people taking DPP-4 inhibitors.
To better understand the real-world impact, the researchers estimated how often these complications occurred. They found that for every 37 patients treated with basal insulin for two years, one additional person would experience a serious cardiovascular event.
For sulfonylureas, one additional serious event occurred for approximately every 103 patients treated over the same period.
Because type 2 diabetes affects such a large number of people, even relatively small increases in risk can have major public health consequences. In the United States alone, around 30 million people live with diabetes.
If millions of patients are using medications associated with higher cardiovascular risks, the overall impact on the healthcare system could be substantial.
The study’s lead researcher, Dr. Matthew O’Brien, believes the findings support greater use of newer diabetes medications that appear to offer better cardiovascular safety. These include GLP-1 receptor agonists such as liraglutide, SGLT-2 inhibitors such as empagliflozin, and DPP-4 inhibitors such as sitagliptin.
Over the past decade, many studies have shown that some of these newer drugs not only help control blood sugar but may also reduce the risk of heart disease and other complications. This has led many diabetes experts to recommend them, particularly for patients who already have cardiovascular disease or who are at high risk of developing it.
Despite these potential benefits, cost remains a major challenge. Sulfonylureas and older forms of insulin are generally much less expensive than newer medications.
Many patients, especially those with limited insurance coverage, may find the newer treatments difficult to afford. As a result, doctors and patients often face difficult decisions when balancing effectiveness, safety, and cost.
One strength of this study is that it relied on real-world patient data rather than highly controlled clinical trials.
By examining the experiences of large numbers of people receiving routine medical care, the researchers were able to gain insight into how these medications perform in everyday life. This type of evidence can provide valuable information that complements traditional clinical trials.
The researchers emphasize that patients should not stop taking any prescribed medication without consulting their healthcare provider. Diabetes treatment decisions are complex and depend on many individual factors, including age, other medical conditions, blood sugar control, and medication costs.
The study was published in JAMA Network Open and adds to growing evidence that heart health should be a major consideration when choosing diabetes treatments. The findings suggest that controlling blood sugar is only one part of successful diabetes care. Choosing medications that protect long-term heart health may be just as important.
As researchers continue to learn more about the benefits and risks of different diabetes treatments, these findings could help doctors and patients make more informed decisions. For many people living with type 2 diabetes, the goal is not only to manage blood sugar but also to reduce the risk of serious complications and enjoy a longer, healthier life.
If you care about heart health, please read studies about top foods to love for a stronger heart, and why oranges may help fight obesity, diabetes, and heart disease.
For more health information, please see recent studies about simple guide to a 7-day diabetes meal plan, and why you should add black beans to your plate.
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