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CV risk similar for second-line diabetes drugs plus metformin
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Adults with type 2 diabetes using metformin combined with insulin have a similar cardiovascular risk when compared with adults using metformin combined with sulfonylureas, according to research in Diabetes, Obesity and Metabolism.
In a population-based case-control study and meta-analysis that included data from an observational study of male veterans with type 2 diabetes using the same combination therapies, researchers found that metformin combined with insulin was associated with no more than a 24% increased CV risk ratio or a 31% decreased risk ratio when compared with metformin combined with sulfonylureas.
James S. Floyd
“Based on this report and another study cited in our report, current evidence suggests that the use of sulfonylureas and insulin as second-line therapies in addition to metformin may not have large differences in CV risk,” James S. Floyd, MD, of the University of Washington in Seattle, told Endocrine Today. “More evidence will be available when results from the GRADE trial become available, although power from that study is limited to detect all but large differences in CV risk.”
Floyd and colleagues analyzed data from 310 adults with type 2 diabetes enrolled in case-control studies at Group Health Cooperative in Washington. Participants were using metformin combined with either insulin or sulfonylureas at the time of a first myocardial infarction (n = 180) or stroke (n = 130) between 1995 and 2010; 331 controls used the same treatment combinations and were randomly sampled from the population. In the metformin and insulin group, 97% of participants used a long-acting insulin; 47% used regular or rapid-acting insulin. In the metformin and sulfonylurea group, 97% used a second-generation sulfonylurea (76% glyburide; 21% glipizide).
Researchers found that the combined use of metformin and insulin was associated with similar risks for MI (OR = 0.96; 95% CI, 0.6-1.56) and stroke (OR = 0.85; 95% CI, 0.47-1.51) when compared with a combined use of metformin and sulfonylurea. Results were similar after researchers adjusted for rapid-acting insulin, duration of sulfonylurea or insulin use, HbA1c and sex.
After combining results with the results from the veterans study (n = 270 events), researchers found that the combined RR for CV events associated with metformin and insulin was 0.92 (95% CI, 0.69-1.24) when compared with metformin and sulfonylurea.
Researchers noted that the “null” results have important health implications, but larger studies are still needed.
“Large comparative effectiveness and safety studies are needed to assess the impact of second- and third-line treatment strategies for type 2 diabetes on CV outcomes,” Floyd said. – by Regina Schaffer
Disclosure: Floyd reports no relevant financial disclosures.
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