Do blood sugar medications increase heart attack risk in patients with diabetes receiving dialysis for kidney disease?

This study investigated if medications used to treat high blood sugar increased the risk of heart attack in patients with diabetes and end-stage kidney disease undergoing dialysis.

This study concluded that patients taking non-insulin drugs were more likely to have a heart attack.

Diabetes is an illness that prevents the production of insulin, which is important for blood sugar control. Patients can develop other complications including kidney and heart disease. End stage kidney disease (ESKD) is treated with dialysis, a machine that filters the patient's blood. Patients who develop kidney disease have an increased risk for low blood sugar, or hypoglycemia. These patients will often be prescribed drugs to reduce blood sugar, called anti-hyperglycemics. These medications, however, can increase the risk of heart attack. Therefore, there may be an increased risk of heart attack in patients who are treated with these medications. 

15,161 patients were included in the study. These patients were diagnosed with diabetes, experiencing ESKD and on dialysis. The medications these patients received were insulin (39%), sulfonylureas (40%), meglitinides (18%) and thiazolidinedione (TZD; 3%). Following an average of 3.5 to 5 years of treatment, a follow-up assessment determined if there were any occurences of heart attack, or myocardial infarction.

The incidence of heart attack was 10.4% in patients taking sulfonylureas, 6.9% in patients taking meglitinides, 9.6% in patients taking TZD and 6.3% in patients taking insulin. The estimated risk of heart attack were significantly greater for those receiving non-insulin drugs: sulfonylureas (52%), meglitinides (25%) and TZD (52%).

This study concluded that non-insulin drugs are associated with a higher risk of heart attack in patients with diabetes and ESKD undergoing dialysis.

Patients taking insulin and sulfonylureas were significantly younger than patients taking the other drugs. There were more patients in the non-insulin drug groups undergoing dialysis. The severity of kidney disease may also have impacted the risk of heart attack. 

If you have any concerns regarding diabetes medications and/or potential diabetes-related diseases then please discuss with your doctor.