Two diabetes drugs linked to higher risk of heart disease

Two commonly prescribed diabetes drugs carry high risk of heart attack, stroke, heart failure, amputation

Two drugs commonly prescribed to treat Type 2 diabetes carry a high risk of cardiovascular events such as heart attack, stroke, heart failure or amputation. This is according to a new study published in JAMA Network Open.

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. The two drugs are used in patients that need a second-line medication because metformin alone didn’t work or wasn’t tolerated.

“This should force providers to think about cardiovascular effects of these drugs early in the course of diabetes treatment”

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 in US (60 percent) who need a second-line drug are prescribed one of these two drugs. 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.

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, said O’Brien, an assistant professor of general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine.

“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 added.