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How Do Older Diabetes Drugs Compare in Their Effects on Heart and Blood Vessel Disease? FREE

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The full report is titled “Comparative Effectiveness of Sulfonylurea and Metformin Monotherapy on Cardiovascular Events in Type 2 Diabetes Mellitus. A Cohort Study.” It is in the 6 November 2012 issue of Annals of Internal Medicine (volume 157, pages 601-610). The authors are C.L. Roumie, A.M. Hung, R.A. Greevy, C.G. Grijalva, X. Liu, H.J. Murff, T.A. Elasy, and M.R. Griffin.

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Ann Intern Med. 2012;157(9):I-28. doi:10.7326/0003-4819-157-9-201211060-00001
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What is the problem and what is known about it so far?

Diabetes makes a person more likely to have a heart attack or stroke. Some newer diabetes drugs used to lower blood sugar levels have been shown to make heart attacks and strokes even more probable—as a result, these drugs have been taken off the market or restricted for use. This experience is a reminder that we know relatively little about the effects of older, commonly used diabetes drugs on heart attacks and strokes.

Why did the researchers do this particular study?

To compare the effects of older diabetes drugs on heart attacks and strokes.

Who was studied?

More than 250,000 veterans with diabetes cared for in Veterans Health Administration hospitals throughout the United States.

How was the study done?

The researchers identified all patients who were newly diagnosed with diabetes and who were starting therapy with 3 older, commonly used diabetes drugs: metformin, glyburide, or glipizide. They combined people using glyburide and glipizide because the 2 drugs are similar. The researchers determined how many people required hospitalization for heart attacks or strokes and how many died in the glyburide and glipizide group compared with the metformin group.

What did the researchers find?

People using metformin were less likely to be hospitalized for a heart attack or stroke or to die than those taking glyburide or glipizide.

What were the limitations of the study?

The findings suggest that metformin is more likely to prevent heart attacks, strokes, and death than glyburide and glipizide. But, because the researchers did not study people who were not taking any diabetes drugs, this study could not determine whether heart attacks, strokes, and death are more or less probable compared with no drug. Factors other than the drugs could have contributed to the differences in heart attacks, strokes, and deaths. However, the researchers did many analyses to find other factors but did not find any. Finally, most study participants were men, so the findings may not apply to women.

What are the implications of the study?

Metformin seems to be better at preventing heart attacks, strokes, and death than glyburide and glipizide and probably should be tried first by people who have a new diagnosis of diabetes and require drug treatment.





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