Risk of mortality and adverse cardiovascular outcomes in type 2 diabetes: a comparison of patients treated with sulfonylureas and metformin - PubMed (original) (raw)
Comparative Study
doi: 10.1007/s00125-006-0176-9. Epub 2006 Mar 9.
Affiliations
- PMID: 16525843
- DOI: 10.1007/s00125-006-0176-9
Free article
Comparative Study
Risk of mortality and adverse cardiovascular outcomes in type 2 diabetes: a comparison of patients treated with sulfonylureas and metformin
J M M Evans et al. Diabetologia. 2006 May.
Free article
Abstract
Aims/hypothesis: The aim of this study was to evaluate the risk of adverse cardiovascular outcomes in patients with type 2 diabetes newly treated with sulfonylureas and metformin.
Subjects and methods: The Diabetes Audit and Research in Tayside Scotland (DARTS) diabetes information system and the Medicines Monitoring Unit (MEMO) dispensed prescribing database for the population of Tayside, Scotland (400,000 people) were employed. Patients newly prescribed with oral hypoglycaemic agents between 1994 and 2001 were classified into five study cohorts according to the treatment received: metformin only, sulfonylureas only, sulfonylureas added to metformin, metformin added to sulfonylureas, and both drugs simultaneously. In Cox regression analyses, we estimated relative risks for all-cause mortality, cardiovascular mortality and cardiovascular hospital admission for patients in the five study cohorts, with metformin monotherapy as the reference group.
Results: Of the 5,730 study patients, 1,000 died during a maximum of 8 years follow-up. Patients in the sulfonylureas only cohort had increased risks of mortality and cardiovascular mortality, with unadjusted relative risks of 3.12 (95% CI 2.54-3.84) and 3.71 (95% CI 2.64-5.22), respectively. After adjusting for differences between groups (age, sex, duration of diabetes, blood pressure, cholesterol, HbA(1c), smoking, previous hospital admission, treatment with cardiovascular medication), these relative risks were 1.43 (95% CI 1.15-1.77) and 1.70 (95% CI 1.18-2.45), respectively. Patients in the combination cohorts had significantly increased risks of cardiovascular hospital admission, as well as increased risks of mortality and cardiovascular mortality.
Conclusions/interpretation: In this cohort study of patients newly treated with oral hypoglycaemic agents, those treated with sulfonylureas only, or combinations of sulfonylureas and metformin, were at higher risk of adverse cardiovascular outcomes than those treated with metformin alone.
Comment in
Similar articles
- Combination therapy with sulfonylureas and metformin and the prevention of death in type 2 diabetes: a nested case-control study.
Azoulay L, Schneider-Lindner V, Dell'aniello S, Schiffrin A, Suissa S. Azoulay L, et al. Pharmacoepidemiol Drug Saf. 2010 Apr;19(4):335-42. doi: 10.1002/pds.1834. Pharmacoepidemiol Drug Saf. 2010. PMID: 20052677 - Antihyperglycemic treatment in diabetics with coronary disease: increased metformin-associated mortality over a 5-year follow-up.
Fisman EZ, Tenenbaum A, Benderly M, Goldbourt U, Behar S, Motro M. Fisman EZ, et al. Cardiology. 1999;91(3):195-202. doi: 10.1159/000006909. Cardiology. 1999. PMID: 10516414 - Sulfonylureas and the Risks of Cardiovascular Events and Death: A Methodological Meta-Regression Analysis of the Observational Studies.
Azoulay L, Suissa S. Azoulay L, et al. Diabetes Care. 2017 May;40(5):706-714. doi: 10.2337/dc16-1943. Diabetes Care. 2017. PMID: 28428321 Review. - Metformin and sulfonylureas in relation to cancer risk in type II diabetes patients: a meta-analysis using primary data of published studies.
Thakkar B, Aronis KN, Vamvini MT, Shields K, Mantzoros CS. Thakkar B, et al. Metabolism. 2013 Jul;62(7):922-34. doi: 10.1016/j.metabol.2013.01.014. Epub 2013 Feb 16. Metabolism. 2013. PMID: 23419783 Review.
Cited by
- Metformin-Associated Lactic Acidosis in an Older Adult: A Case Report and Review.
Jain S, Sekhon S, Leo Pradeep Chandran AS, Gummadi J, Patel P, Nakka R, Gunendran T, Nanjundappa A, Jose T, Garapati HN, Palasamudram Shekar S, Kanitkar A. Jain S, et al. Cureus. 2024 Jun 19;16(6):e62729. doi: 10.7759/cureus.62729. eCollection 2024 Jun. Cureus. 2024. PMID: 39036128 Free PMC article. - Insights on the role of anti-inflammatory and immunosuppressive agents in the amelioration of diabetes.
Rai U, Senapati D, Arora MK. Rai U, et al. Diabetol Int. 2022 Nov 17;14(2):134-144. doi: 10.1007/s13340-022-00607-9. eCollection 2023 Apr. Diabetol Int. 2022. PMID: 37090130 Free PMC article. Review. - Metformin Monotherapy Alters the Human Plasma Lipidome Independent of Clinical Markers of Glycemic Control and Cardiovascular Disease Risk in a Type 2 Diabetes Clinical Cohort.
Wancewicz B, Zhu Y, Fenske RJ, Weeks AM, Wenger K, Pabich S, Daniels M, Punt M, Nall R, Peter DC, Brasier A, Cox ED, Davis DB, Ge Y, Kimple ME. Wancewicz B, et al. J Pharmacol Exp Ther. 2023 Aug;386(2):169-180. doi: 10.1124/jpet.122.001493. Epub 2023 Mar 14. J Pharmacol Exp Ther. 2023. PMID: 36918276 Free PMC article. - Effect of metformin on adverse outcomes in T2DM patients: Systemic review and meta-analysis of observational studies.
Xu Z, Zhang H, Wu C, Zheng Y, Jiang J. Xu Z, et al. Front Cardiovasc Med. 2022 Sep 23;9:944902. doi: 10.3389/fcvm.2022.944902. eCollection 2022. Front Cardiovasc Med. 2022. PMID: 36211585 Free PMC article. - A Clinical Perspective of the Multifaceted Mechanism of Metformin in Diabetes, Infections, Cognitive Dysfunction, and Cancer.
Chow E, Yang A, Chung CHL, Chan JCN. Chow E, et al. Pharmaceuticals (Basel). 2022 Apr 2;15(4):442. doi: 10.3390/ph15040442. Pharmaceuticals (Basel). 2022. PMID: 35455439 Free PMC article. Review.
References
- Diabetes Care. 2002 Dec;25(12):2244-8 - PubMed
- Health Bull (Edinb). 1990 Jul;48(4):162-75 - PubMed
- N Engl J Med. 1998 Jul 23;339(4):229-34 - PubMed
- Diabetologia. 1996 May;39(5):503-14 - PubMed
- Lancet. 1998 Sep 12;352(9131):854-65 - PubMed
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Miscellaneous