Second-Line Antidiabetic Meds May Impact Cardiovascular Risk
Cardiovascular risk increased with sulfonylureas and basal insulin versus newer classes of ADM
(HealthDay News) -- For adults with type 2 diabetes initiating second-line antidiabetic medications (ADM), cardiovascular risk is increased with use of sulfonylureas or basal insulin versus newer ADM classes, according to a study published online in JAMA Network Open.
Matthew J. O'Brien, MD, from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues examined the correlation of second-line ADM classes with major adverse cardiovascular events in a cohort of 132,737 insured adults with type 2 diabetes. Participants started therapy with a second-line ADM after taking metformin alone or no prior ADM.
There were 3480 incident cardiovascular events during 169,384 person-years of follow-up. The researchers found that the risk for composite cardiovascular events was lower after patients started glucagon-like peptide-1 (GLP-1) receptor agonists versus dipeptidyl peptidase 4 (DPP-4) inhibitors, after adjustment for patient, prescriber, and health plan characteristics (hazard ratio, 0.78); this finding was not significant in all sensitivity analyses. Cardiovascular event rates were not significantly different after patients started treatment with sodium-glucose cotransporter 2 (SGLT-2) inhibitors and thiazolidinediones vs DPP-4 inhibitors. A higher comparative risk for cardiovascular events was seen after patients started treatment with sulfonylureas or basal insulin (hazard ratios, 1.36 and 2.03, respectively) vs DPP-4 inhibitors.
"Clinicians may consider prescribing GLP-1 receptor agonists, DPP-4 inhibitors, or SGLT-2 inhibitors more routinely after metformin rather than sulfonylureas or basal insulin," the authors write.
Two authors disclosed financial ties to the biopharmaceutical industry.
O'Brien MJ , Karam SL, Wallia A, et al. Association of Second-line Antidiabetic Medications With Cardiovascular Events Among Insured Adults With Type 2 Diabetes.
JAMA Netw Open. 2018;1(8):e186125. DOI:10.1001/jamanetworkopen.2018.6125
Callahan A and Shah NH. A Second Opinion From Observational Data on Second-line Diabetes Drugs. JAMA Netw Open. 2018;1(8):e186119. DOI:10.1001/jamanetworkopen.2018.6119