Commonly prescribed drugs carry high
risk of heart attack, stroke, heart failure, amputation
“People should know if the
medications they’re taking to treat their diabetes could lead to serious
cardiovascular harm,” said lead author Dr. 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.
60%The percentage of Type 2
diabetes patients nationwide in need of second-line treatment who are
prescribed one of these two drugs
The two drugs -- sulfonylureas and
basal insulin -- are commonly prescribed to patients after they have taken
metformin, a widely accepted initial Type 2 diabetes treatment, but need a
second-line medication because metformin alone didn’t work or wasn’t tolerated.
This is the first study 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 the other type of insulin (prandial insulin), which is faster acting and intended to be taken before meals.
More than half of patients
nationwide (60 percent) who need a second-line drug are prescribed one of these
two drugs, the study found.
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.
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 said.
“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.”
“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, the study authors suggest.
These drugs, however, are more
expensive than the sulfonylureas, which is the main reason they are not as
commonly prescribed, O’Brien said.
“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,” O’Brien said.
This was an observational study
using data from 132,737 patients with Type 2 diabetes who were
starting second-line treatment. The scientists were, therefore, able to use
real-world evidence that complements findings from previous randomized trials
which studied only one active drug compared to placebo.