In a recent study, researchers found an association between two second-line antidiabetic medications (ADMs)—sulfonylureas and basal insulin—and adverse cardiovascular effects.
The retrospective cohort study included 132,737 adults type 2 diabetes patients (55% male; age range, 45–64 years) who initiated a second-line ADM after taking either metformin alone or no prior ADM. Between January 2017 and October 2018, researchers gathered United States nationwide administrative claims data from 2011–2015.
Starting 2nd-line diabetes treatment, GLP-1 agonists, DPP-4 inhibitors & SGLT-2 inhibitors may have lower CV risk than sulfonylureas or basal insulin https://t.co/rJ99k8l1WA pic.twitter.com/tYSzu1qnjC
— JAMA Network Open (@JAMANetworkOpen) December 23, 2018
During the study period, 3,480 incident cardiovascular events occurred.
In adjusted analyses, patients initiating GLP-1 receptor agonists were less likely to report cardiovascular events than patients taking DPP-4 inhibitors (hazard ratio [HR], 0.78; 95% CI, 0.63-0.96), but this was not universal across all analyses. The rate of cardiovascular events did not significantly differ among DPP-4 inhibitor patients and those using SGLT-2 inhibitors (HR, 0.81; 95% CI, 0.57-1.53) and TZDs (HR, 0.92; 95% CI, 0.76-1.11). The researchers observed a greater cardiovascular risk in patients who initiated treatment with sulfonylureas (HR, 1.36; 95% CI, 1.23-1.49) or basal insulin (HR, 2.03; 95% CI, 1.81-2.27) than DPP-4 inhibitors.
Higher CV risk was associated w sulfonylureas or basal insulin compared with GLP-1RA, SGLT-2i or DPP-4i more routinely after metformin rather than sulfonylureas or basal insulin. Need to change old RX strategy https://t.co/3gUgRUaHVo
— Thomas Dayspring (@Drlipid) December 26, 2018
Sulfonylureas and basal insulin collectively comprised more than half of ADM prescriptions, the researchers noted: “Sulfonylureas composed 47.6% of index ADM fills, followed by DPP-4 inhibitors (21.8%), basal insulin (12.2%), GLP-1 receptor agonists (8.6%), TZDs (5.6%), and SGLT-2 inhibitors (4.3%).”
New evidence in @JAMANetworkOpen that #BasalInsulin and #Sulfonylureas might bring a risk of #heart problems, as well as #WeightGain. https://t.co/KW8eHmrwD1 pic.twitter.com/szizRuJUm8
— Ted Kyle (@ConscienHealth) December 27, 2018
Study author Matthew O’Brien, MD, MSc, assistant professor of general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician, said that slightly reducing the number of patients prescribed either medication could significantly impact cardiovascular effects.
Study links insulin, sulfonylureas to increased CV risk in diabetes https://t.co/APbJcw9cpu
— Nima Patel-Shori (@NimaPatelShori) December 24, 2018
“According to our findings, we only have 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,” O’Brien said. “For sulfonylureas, that number was a bit higher—103 people. But when you apply these numbers to 30 million Americans with diabetes, this has staggering implications for how we may be harming many patients.”
“People should know if the medications they’re taking to treat their diabetes could lead to serious cardiovascular harm,” he added. “This calls for a paradigm shift in the treatment of type 2 diabetes.”
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Sources: JAMA, Northwestern
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