Death Risk Higher With Sulphonylureas

Patients with diabetes who receive sulphonylureas (SUs) are more at risk of cardiovascular disease-related events compared with patients who receive other glucose lowering drugs, according to a review published in Diabetes, Obesity and Metabolism.

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For the review, researchers led by Steve Bain MD, Swansea University, United Kingdom, conducted a systematic review of Medline, Embase, Cochrane, and clinicaltrials.gov for studies comparing SUs with placebo or other antihyperglycemic drugs in patients with type 2 diabetes. They also used statistical analyses to obtain comparative hazard ratios and examine observational data.

A total 82 randomized clinical trials and 26 observational studies were identified and included in the review. In the randomized controlled trials, researchers found that risk of all-cause mortality and cardiovascular-related mortality were both higher in patients treated with SUs compared with all other therapeutic regimens combined (HR 1.26, 95% confidence interval [CI] 1.10-1.44 and HR 1.46, 95% CI 1.21-1.77, respectively).

Further, myocardial infarction risk was slightly higher for the SU compared with dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose co-transporter-2 inhibitors (HR 2.54, 95% CI 1.14-6.57 and HR 41.80, 95% CI 1.64-360.4, respectively). Stroke risk was also significantly higher among patients who received SUs compared with all other glucose-lowering drugs in the study.

Therefore, researchers concluded that there was a distinct association between SU therapy and higher risk of major cardiovascular disease-related events compared with other glucose-lowering drugs. However, they stipulate that the results of ongoing clinical trials are expected to provide more definitive results in 2018.--Sean McGuire

Reference

Bain S, Druyts E, Balijepalli C, et al. Cardiovascular events and all-cause mortality associated with sulphonylureas compared with other antihyperglycaemic drugs: A Bayesian meta-analysis of survival data. Diabetes Obes Metab. 2016. doi: 10.1111/dom.12821.