GPs should consider alternatives to sulphonylureas in patients with Type 2 diabetes as their use is linked to an increase in cardiovascular disease, claim researchers.
The US meta-analysis of 33 randomised and observational studies included 1,325,446 patients with diabetes a mean age ranging from 52 to 76 years. Cardiovascular composite endpoints such as a major cardiovascular event, cardiovascular death or stroke were compared for patients with diabetes taking sulphonylureas, compared with other diabetes treatments, such as metformin and thiazolidinediones. Ratios were adjusted for potential confounders including baseline cardiovascular risk, concomitant medications and diabetes severity.
A significant association between sulphonylurea use and cardiovascular mortality was seen, with a relative risk 1.27 compared with other diabetes treatments. Sulphonylurea use was also significantly associated with a 10% increased risk of the cardiovascular composite endpoint, compared with other diabetes treatments. Sulphonylureas were associated with a 16% increased risk of the cardiovascular composite endpoint when compared with metformin. Statistical pooling found no statistically significant associations between sulphonylureas use and stroke, compared with other diabetes treatments.
What this means for GPs
The researchers concluded that their results ‘warrant consideration in clinical practice, when other treatment options may be available’.