A recent study has raised concerns about two classes of medications widely used for type 2 diabetes, sulfonylureas and basal insulin, suggesting they may be linked to an increased risk of cardiovascular disease. These drugs, often prescribed after metformin inadequacy, can lead to serious harm, prompting calls for a change in treatment strategies.
Key takeaways
- Two common type 2 diabetes medications, sulfonylureas and basal insulin, are associated with increased cardiovascular risk.
- Patients taking these medications are more likely to have heart attacks, strokes, heart failure, or amputations than those taking newer drug classes.
- The findings indicate the need for a paradigm shift in how type 2 diabetes is treated, with priority given to newer drugs with better cardiovascular properties.
Increased cardiovascular risk has been identified
A landmark study published in JAMA Network Open identified a potential link between sulfonylureas and basal insulin, commonly prescribed second-line treatments for type 2 diabetes, and a higher risk of cardiovascular disease. These events can include heart attackStroke, heart failure, and even amputation. The research indicates that patients taking sulfonylureas are 36% more likely, and those taking basal insulin are twice as likely to suffer this damage compared to individuals using newer medications such as DPP-4 inhibitors.
A call for a qualitative shift in treatment
Matthew O’Brien, MD, lead author of the study and assistant professor at Northwestern University Feinberg School of Medicine, stressed the urgent need for patients and healthcare providers to be aware of these risks. “People should know if the medications they take to treat diabetes could lead to serious damage to their heart and blood vessels,” O’Brien said. “This calls for a paradigm shift in the treatment of type 2 diabetes.”
The study highlights that more than 60% of patients require a second line Diabetes medication Either a sulfonylurea or basal insulin is prescribed. The implications of this are staggering, as calculations suggest that for every 37 people treated with basal insulin over two years, one case of cardiovascular disease would be observed. For sulfonylureas, this number increases to 103 people.
Explore alternative treatments
The researchers suggest that clinicians should consider routinely prescribing newer classes of antidiabetic drugs after metformin. These include GLP-1 agonists (eg, liraglutide), SGLT-2 inhibitors (eg, empagliflozin), and DPP-4 inhibitors (eg, sitagliptin). While these newer drugs are more expensive than sulfonylureas, their more favorable cardiovascular properties may provide a safer treatment option in the long term.
Understanding the mechanism of sulfonylurea
Additional research by the University of Barcelona suggests that sulfonylureas may not only increase the risk of cardiovascular disease, but may also worsen the development of type 2 diabetes itself. These drugs, in use since the 1950s, work by stimulating insulin secretion from pancreatic beta cells. However, new findings suggest that prolonged exposure to sulfonylureas may cause beta cells to lose their functional identity and impair their ability to effectively produce and secrete insulin. This could explain the decreased effectiveness of sulfonylureas over time and their potential contribution to disease progression.
