How do treatment choices in type 2 diabetes affect cardiovascular and overall risk?

This study investigated the effectiveness of two drug combinations in type 2 diabetes and compared the associated cardiovascular and overall risk. 

Diabetes is associated with increased cardiovascular risk (including heart attack or stroke). Metformin (Glucophage) is recommended as the first line of treatment (first treatment after diagnosis) for type 2 diabetes. Another glucose (sugar)-lowering drug is often prescribed to be taken alongside metformin once the therapeutic effect has reduced.  

Drugs belonging to a number of different classes such as sulfonylureas and dipeptidyl peptidase-4inhibitors, are recommended as second-line options. Examples of  sulfonylureas  include glimepiride (Amaryl), glipizide (Glucotrol) and glyburide (DiaBeta). Sitagliptin (Januvia), linagliptin (Tradjenta) and saxagliptin (Onglyza) are examples of dipeptidyl peptidase-4inhibitors. Sulfonylureas have been described as being more effective at lowering blood glucose. However studies have also shown that risk of low blood sugar and cardiovascular events are more common than for other drugs. The benefits and disadvantages of each class of drug should be taken into account when selecting the best treatment option for the patient.  

This study aimed to identify the relationship between sulfonylurea and dipeptidyl peptidase-4 inhibitor treatment with cardiovascular and overall risk in type 2 diabetes patients being treated with metformin. 33, 983 patients were treated with metformin and sulfonylurea and 7,864 were treated with metformin and dipeptidyl peptidase-4 inhibitor. The occurrence of cardiovascular events and all-cause mortality (death due to any cause) was calculated.  

Sulfonylurea treatment was associated with a 54% higher frequency of heart attack or stroke than dipeptidyl peptidase-4 inhibitor treatment. All-cause mortality risk (risk of death due to any cause) was also higher (by 49%) in this group.

The authors concluded that though sulfonylurea treatment has previously been suggested as second-line treatment to metformin, the associated cardiovascular and overall risk should be taken into account when making treatment decisions.

The patients in the group being treated with sulfonylurea were different to the dipeptidyl peptidase-4 inhibitor patients as regards age, blood sugar level and the duration they had diabetes. This makes it more difficult to draw true implications from the findings.

Consult your doctor if you feel you need additional treatment to metformin, or if you feel that your current treatment plan could be improved.