New study results show that first-line therapy with sulfonylureas significantly increases the risk for death in patients with Type 2 diabetes compared to treatment with metformin. The combination of metformin and a sulfonylurea was also associated with a significantly increased mortality risk compared with combination therapy with metformin and a dipeptidyl peptidase-4 (DPP-4) inhibitor (or “gliptin”).
Prof. Craig Currie of the University of Cardiff presented the results of two studies during a meeting of the European Association for the Study of Diabetes (EASD). Currie said the findings should be a wake-up call about the hazards of prescribing sulfonylureas to diabetic patients, Medscape Medical News reports. “People should avoid using a drug where the balance of evidence, at the moment, demonstrates that it kills people,” he said. Sulfonylureas help control blood sugar by increasing the amount of insulin produced by the pancreas.
In the first new analysis reported at the EASD meeting, researchers had analyzed the UK Clinical Practice Research Datalink (CPRD), a data set of more than 10 million patients representative of the UK population. The researchers identified 15,687 Type 2 diabetes patients treated with the sulfonylureas alone. For comparison, they used 76,811 diabetic patients treated with metformin. There were 13.6 deaths per 1,000 person-years with metformin and 44.6 deaths per 1,000 person-years with sulfonylureas. This translated into a 58 percent increased risk for all-cause mortality among diabetics treated with sulfonylureas as monotherapy.
Dr. Currie said that although sulfonylureas—such as glipizide, glyburide, and glimepiride—have largely been replaced by metformin as first-line therapy, the present study showed that approximately 17 percent of patients sampled were still receiving them as monotherapy, according to Medscape Medical News.
Dr. Andreas Pfeiffer of from Charité Universitätsmedizin, Berlin, who no longer uses sulfonylureas, cited treatment cost as the main reason the class of drugs is still used frequently. The newer DPP-4 inhibitors can cost substantially more per month.
Ongoing cardiovascular-safety trials of a new diabetes drug, linagliptin (Tradjenta) are expected to yield more data in this debate, according to Medscape Medical News.