Insulin Secretagogues May Increase Mortality Risk

Insulin secretagogue monotherapy has comparatively higher mortality risk than metformin

FRIDAY, April 8 (HealthDay News) -- Patients with type 2 diabetes treated with insulin secretagogue (IS) monotherapy are at increased risk of all-cause, cardiovascular, and composite (myocardial infarction [MI], stroke, and cardiovascular) mortality compared to those treated with metformin, according to a study published online April 6 in the European Heart Journal.

Tina Ken Schramm, M.D., from the Copenhagen University Hospital in Denmark, and colleagues compared the mortality and cardiovascular risk between individual IS monotherapy and metformin. The study included 107,806 patients aged 20 years or older with type 2 diabetes, 9,607 of who had suffered from a previous MI. Single-agent IS or metformin therapy was initiated between 1997 and 2006. The participants were followed up for a maximum of nine years, during which time the all-cause, cardiovascular, and composite mortality associated with individual ISs were determined.

The investigators found that, compared to metformin, ISs were associated with increased all-cause mortality in patients with previous MI: glimepiride (hazard ratio [HR], 1.30), glibenclamide (HR, 1.47), glipizide (HR, 1.53), and tolbutamide (HR, 1.47); and in patients without previous MI: glimepiride (HR, 1.32), glibenclamide (HR, 1.19), glipizide (HR, 1.27), and tolbutamide (HR, 1.28). All-cause mortality for gliclazide and repaglinide was not statistically different from metformin in patients with or without previous MI. Cardiovascular and composite mortality had similar results for patients without and with previous MI.

"We demonstrated increased mortality and cardiovascular risk associated with the most used ISs in patients at relatively low and high cardiovascular risk, when compared with metformin," the authors write.

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