Lorraine Lipscombe, MD, MSc, FRCPC
In patients with type 2 diabetes, how do various oral diabetes medications compare for long-term cardiovascular (CV) risk?
Included studies evaluated oral metformin (MET), second-generation sulfonylureas (SFUs), thiazolidinediones (TZDs), or meglitinides for CV risk in type 2 diabetes. Studies of any 3 oral diabetes drug combinations, first-generation SFUs, or α-glucosidase inhibitors; that were < 3 months’ duration; or that enrolled < 40 patients were excluded. Outcomes were CV morbidity, CV mortality, and all-cause mortality.
MEDLINE, EMBASE/Excerpta Medica, and Cochrane Central Register of Controlled Trials were searched to January 2006 for randomized controlled trials (RCTs). 40 RCTs (mean age range 52 to 69 y) met the selection criteria. Duration of follow-up ranged from 3 months to 11 years. Mean Jadad score was 3 out of 5.
Meta-analysis showed that MET reduced risk for CV mortality but did not differ from other drugs or placebo for CV morbidity or all-cause mortality (Table). Other drugs and their comparators did not differ for any outcome (Table).
Metformin reduced risk for cardiovascular mortality compared with other oral diabetes drugs or placebo in type 2 diabetes.
Oral diabetes drugs vs other comparators for cardiovascular (CV) risk in type 2 diabetes*
*MET = metformin; PIO = pioglitazone; ROS = rosiglitazone; SFU = sulfonylurea; other abbreviations defined in Glossary. Weighted event rates, RRR, RRI, NNT, NNH, and CI calculated from control event rates provided by author and odds ratios in article using a fixed-effect model.
†Information provided by author.
‡Weighted event rates, RRR, NNT, and CI calculated from event rates provided by author.
Lipscombe L. Review: Metformin reduces risk for CV mortality compared with other oral diabetes drugs or placebo in type 2 diabetes. Ann Intern Med. ;150:JC4–8. doi: 10.7326/0003-4819-150-8-200904210-02008
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Published: Ann Intern Med. 2009;150(8):JC4-8.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Prevention/Screening.
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