Two drugs commonly prescribed to treat Type 2 diabetes carry a high risk of cardiovascular events, including heart attack, stroke, heart failure, or amputation, a new study warns.

“People should know if the medications they’re taking to treat their diabetes could lead to serious cardiovascular harm,” says lead author Matthew O’Brien, assistant professor of general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. “This calls for a paradigm shift in the treatment of Type 2 diabetes.”

The two drugs—sulfonylureas and basal insulin—are commonly prescribed when metformin, a widely accepted initial Type 2 diabetes treatment, doesn’t work alone or isn’t tolerated.

The study, which appears in JAMA Network Open, is the first to compare how each of the six major second-line drugs impact cardiovascular outcomes in Type 2 diabetes patients taking a second diabetes medication.

Basal insulin is engineered to release slowly over the course of the day, compared to faster acting prandial insulin, which is taken before meals.

“…when you apply these numbers to 30 million Americans with diabetes, this has staggering implications for how we may be harming many patients.”

One of these two drugs are prescribed to more than half of patients nationwide (60 percent) who need a second-line drug. Yet, patients who take one of these two drugs are more likely—36 percent more for sulfonylureas and twice as likely for basal insulin—to experience cardiovascular harm than those taking a newer class of diabetes drugs known as DPP-4 inhibitors, the authors report.

“According to our findings, we only have to prescribe basal insulin to 37 people over two years to observe one cardiovascular event, such as a heart attack, stroke, heart failure, or amputation,” O’Brien says. “For sulfonylureas, that number was a bit higher—103 people. But when you apply these numbers to 30 million Americans with diabetes, this has staggering implications for how we may be harming many patients.”

Physicians should consider prescribing newer classes of antidiabetic medications, such as GLP-1 agonists (e.g., liraglutide), SGLT-2 inhibitors (e.g., empagliflozin), or DPP-4 inhibitors (e.g., sitagliptin), more routinely after metformin, rather than sulfonylureas or basal insulin, researchers say.

These drugs, however, are more expensive than the sulfonylureas, which is the main reason they are not as commonly prescribed, O’Brien says.

“This should force providers to think about cardiovascular effects of these drugs early in the course of diabetes treatment, and shift prescribing patterns to newer drugs that have more favorable cardiovascular profiles.”

This was an observational study using data from 132,737 patients with Type 2 diabetes who were starting second-line treatment. The scientists used real-world evidence that complements findings from previous randomized trials which studied only one active drug compared to a placebo.

Source: Northwestern University

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