Risk of mortality and adverse cardiovascular outcomes in type 2 diabetes: a comparison of patients treated with sulfonylureas and metformin
Open accessAbstract
Aims/hypothesis The aim of this study was to evaluate the risk of adverse cardiovascular outcomes in patients with type 2 diabetes newly treated with sulfonylureas and metformin.Subjects and methods The Diabetes Audit and Research in Tayside Scotland (DARTS) diabetes information system and the Medicines Monitoring Unit (MEMO) dispensed prescribing database for the population of Tayside, Scotland (400,000 people) were employed. Patients newly prescribed with oral hypoglycaemic agents between 1994 and 2001 were classified into five study cohorts according to the treatment received: metformin only, sulfonylureas only, sulfonylureas added to metformin, metformin added to sulfonylureas, and both drugs simultaneously. In Cox regression analyses, we estimated relative risks for all-cause mortality, cardiovascular mortality and cardiovascular hospital admission for patients in the five study cohorts, with metformin monotherapy as the reference group.Results Of the 5,730 study patients, 1,000 died during a maximum of 8 years follow-up. Patients in the sulfonylureas only cohort had increased risks of mortality and cardiovascular mortality, with unadjusted relative risks of 3.12 (95% CI 2.54-3.84) and 3.71 (95% CI 2.64-5.22), respectively. After adjusting for differences between groups (age, sex, duration of diabetes, blood pressure, cholesterol, HbA(1c), smoking, previous hospital admission, treatment with cardiovascular medication), these relative risks were 1.43 (95% CI 1.15-1.77) and 1.70 (95% CI 1.18-2.45), respectively. Patients in the combination cohorts had significantly increased risks of cardiovascular hospital admission, as well as increased risks of mortality and cardiovascular mortality.Conclusions/interpretation In this cohort study of patients newly treated with oral hypoglycaemic agents, those treated with sulfonylureas only, or combinations of sulfonylureas and metformin, were at higher risk of adverse cardiovascular outcomes than those treated with metformin alone.
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Epidemiological investigations suggest patients on sulfonylureas have a higher cardiovascular disease event rate than those on metformin.
“Epidemiological investigations suggest that patients on SUs have a higher cardiovascular disease event rate than those on metformin.”
From Metformin: An Old But Still the Best Treatment for Type 2 Diabetes (2013) · cites this paper as [27]
Patients who started sulfonylureas first and added metformin had higher rates of cardiovascular disease events compared with those who started metformin first and added sulfonylureas.
“Patients who started SUs first and added metformin also had higher rates of cardiovascular disease events compared with those who started metformin first and added SUs.”
From Metformin: An Old But Still the Best Treatment for Type 2 Diabetes (2013) · cites this paper as [27]
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Differential Effects of Oral Hypoglycemic Agents on Glucose Control and Cardiovascular Risk
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- Authors
- Evans, J. M. M., Ogston, S. A., Emslie-Smith, A., & Morris, A. D.
- Affiliations
- University of Dundee (GB)
- The Mill (GB)
- Corresponding author
- Evans, J. M. M.
- Venue
- Diabetologia
- Published
- 2006-03-09
- Volume
- 49
- Issue
- 5
- Pages
- 930-936
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2114349038
- Cited by
- 293
- References
- 19
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 5 · 2023: 6 · 2022: 8 · 2021: 7 · 2020: 13 · 2019: 13 · 2018: 15 · 2017: 11 · 2016: 21 · 2015: 13 · 2014: 23 · 2013: 28 · 2012: 24
- FWCI
- 14.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (submittedVersion)
- Stirling Online Research Repository (University of Stirling) (submittedVersion, public-domain)
- Funders
- Diabetes UK
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, sulfonylureas, metformin, oral antidiabetic drugs, cardiovascular mortality, all-cause mortality, cardiovascular hospital admissions, cardiovascular adverse events, combination therapy, newly treated patients
- MeSH terms
- Adult, Aged, Blood Pressure, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Drug Therapy, Combination, Female, Hospitalization, Humans, Male, Metformin, Middle Aged, Retrospective Studies, Risk Factors, Scotland, Sulfonylurea Compounds, Survival Analysis
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