Sulphonylureas Linked To Diabetes Complications In New Type 2 Diabetes Review

[DCUK NewsBot]

A new study has reviewed the benefits of sulphonylureas as second-line treatment for people with type 2 diabetes. Sulphonylureas are drugs which control blood sugar levels by stimulating insulin production in the pancreas. They may be added to metformin or used as standalone treatment. The results from a new US study have linked the use of sulphonylureas instead of, or alongside metformin, with an increased risk of cardiovascular disease. A total of 77,000 people with type 2 diabetes were analysed who started taking metformin between 1998-2013. At a follow-up investigation just under 26,000 people had been given a sulphonylurea as a second-line treatment. The findings, published in the BMJ journal, suggest those took a sulphonylurea were 26% more likely to have a heart attack, and the risk of death was 28% higher compared with those who remained on metformin alone. There were also similar risks in the study associated with those who stopped taking metformin completely and replaced the medication with a sulphonylurea. "These data suggest that adding a sulphonylurea to metformin treatment is preferable to switching to sulphonylurea monotherapy," the researchers wrote. "It also suggests that continuing metformin alone and accepting higher HbA1c targets is preferable to switching to sulphonylureas when considering both macrovascular outcomes and hypoglycemia." Whilst the study shows that sulphonylureas to be associated with increased risks of heart disease and higher mortality, it is important that people do not stop taking these medications as a result. If you are taking sulphonylurea drugs, and have questions or concerns, your doctor should able to discuss these with you to help you make informed decisions as there are a number of factors that can affect heart disease risk. Research from our Low Carb Program shows that more than 40% of people with type 2 diabetes who start the program on medication have been able to improve their blood sugar levels and reduce their medication needs after 1-year.

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[kitedoc]

A new study has reviewed the benefits of sulphonylureas as second-line treatment for people with type 2 diabetes. Sulphonylureas are drugs which control blood sugar levels by stimulating insulin production in the pancreas. They may be added to metformin or used as standalone treatment. The results from a new US study have linked the use of sulphonylureas instead of, or alongside metformin, with an increased risk of cardiovascular disease. A total of 77,000 people with type 2 diabetes were analysed who started taking metformin between 1998-2013. At a follow-up investigation just under 26,000 people had been given a sulphonylurea as a second-line treatment. The findings, published in the BMJ journal, suggest those took a sulphonylurea were 26% more likely to have a heart attack, and the risk of death was 28% higher compared with those who remained on metformin alone. There were also similar risks in the study associated with those who stopped taking metformin completely and replaced the medication with a sulphonylurea. "These data suggest that adding a sulphonylurea to metformin treatment is preferable to switching to sulphonylurea monotherapy," the researchers wrote. "It also suggests that continuing metformin alone and accepting higher HbA1c targets is preferable to switching to sulphonylureas when considering both macrovascular outcomes and hypoglycemia." Whilst the study shows that sulphonylureas to be associated with increased risks of heart disease and higher mortality, it is important that people do not stop taking these medications as a result. If you are taking sulphonylurea drugs, and have questions or concerns, your doctor should able to discuss these with you to help you make informed decisions as there are a number of factors that can affect heart disease risk. Research from our Low Carb Program shows that more than 40% of people with type 2 diabetes who start the program on medication have been able to improve their blood sugar levels and reduce their medication needs after 1-year.

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I really wonder why has this appeared now when sulphonylureas have been around for yonks, and I wonder at the banality of the statement in 2018 'continuing metformin alone and accepting higher HBA1C targets is preferable to switching to sulphonylurea monotherapy' when most folks know that there are so many other treatment options.

 

[ROSIE1988]

Well well.

 

[kokhongw]

The findings, published in the BMJ journal, suggest those took a sulphonylurea were 26% more likely to have a heart attack, and the risk of death was 28% higher compared with those who remained on metformin alone.

Is it surprising that more insulin to overcome insulin resistance is not the optimal answer?

 

[bulkbiker]

I really wonder why has this appeared now when sulphonylureas have been around for yonks, and I wonder at the banality of the statement in 2018 'continuing metformin alone and accepting higher HBA1C targets is preferable to switching to sulphonylurea monotherapy' when most folks know that there are so many other treatment options.

And the most effective are probably dietary changes that will cause no harm whatsoever.

 

[Oldvatr]

And the most effective are probably dietary changes that will cause no harm whatsoever.

Let us hope that in 30 years time there is not a scientific study that shows that a Low Carb keto diet is not as safe as we believe it to be, It is still early days for us and we do not have the long term data to base such statements on. I know that early attempts at a keto diet (e.g. Atkins#1 and others) was harmful to some, and they have had to rejig the protocols leading up to Atkins#2 which is what is on offer today. I personally know a couple of people who ended up in A&E on that original diet, and yes, I am more cautious now.

 

[Oldvatr]

The phase 1 sulfonyl drugs had a bad record to start with. The later Stage 2 updates do not have such a history so far. It depends on how the study was conducted before my hackles rise. Certainly there is speculation that this type of drug leads to beta cell burnout, but so far I have not seen any evidence linking this mechanism to the Stage 2 drugs, Again it may be just that the sins of the stage 1 fathers are visited on their stage 2 sons, and in reality there may not actually be direct read across. We get this with animal experiments being used to prove drugs are safe for humans.

I see that Pioglitizone is still being prescribed by NICE even though it has been proven that there was a direct causal link to CVE. My 2 strokes gives a personal (n=1) record of this.

I have reduced my daily dose from 320 mg to 40 mg by using diet/ lifestyle changes, but I feel comfortable with the bit that remains compared to all the other nasty chemicals I have in my pillbox.

 

[Oldvatr]

Is it surprising that more insulin to overcome insulin resistance is not the optimal answer?

I liken that methodology as being akin to fattening the geese prior to making pate foie gras.

 

[bulkbiker]

Let us hope that in 30 years time there is not a scientific study that shows that a Low Carb keto diet is not as safe as we believe it to be

I fail to see how a few hundred thousand years of eating that way can prove to be deleterious to mankind or we wouldn't be here now..

 

[Oldvatr]

I fail to see how a few hundred thousand years of eating that way can prove to be deleterious to mankind or we wouldn't be here now..

Firstly I think the type of diet eaten by our ancestors that far back in time would not be capable of sustaining the population levels we suffer from today, Secondly, their lifespan was considerably reduced compared to ours today.

They ran a life experiment recently at Butser Iron Age encampment, using the type of foods and tools available, and found that it would have been very difficult indeed to maintain a healthy diet. I would not want to live like that.

 

[Indy51]

Secondly, their lifespan was considerably reduced compared to ours today.

A couple of articles that argue against this common assumption:

https://aeon.co/ideas/think-everyone-died-young-in-ancient-societies-think-again
https://www.marksdailyapple.com/bone-dating-life-span/

Slide from a talk by Dr Staffan Lindeberg:

 

[Oldvatr]

A couple of articles that argue against this common assumption:

https://aeon.co/ideas/think-everyone-died-young-in-ancient-societies-think-again
https://www.marksdailyapple.com/bone-dating-life-span/

Slide from a talk by Dr Staffan Lindeberg:

I am not going to comment since I think we have strayed well away from the main topic of this thread, which is an important one for those of us using sulfonyl drugs. Sorry for the derailment, folks

 

[Moggely]

I actually thought the Atkins diet was good and doesn't seem to different to Keto so i think I'm sort of doing both. Could be wrong though. My trouble is i don't sort of get the fat bit and how much you should have on Keto. I have the carbs and protein done pat......

 

[Oldvatr]

I actually thought the Atkins diet was good and doesn't seem to different to Keto so i think I'm sort of doing both. Could be wrong though. My trouble is i don't sort of get the fat bit and how much you should have on Keto. I have the carbs and protein done pat......

The revised Atkins diet of today is quite similar to the LCHF diet discussed on the forum and elsewhere. It used to have unlimited protein which caused problems for some people. It now has an upper limit on protein, I believe, to protect the kidneys.

 

[Moggely]

Ahhh I see@OLdvatr i remember a bout 20 years ago i did the Atkins just for weight lose and it sure worked. Now I'm finding i don't have so much meat as then so i think I'm doing Keto but didn't really know it.

 

[bulkbiker]

I actually thought the Atkins diet was good and doesn't seem to different to Keto so i think I'm sort of doing both. Could be wrong though. My trouble is i don't sort of get the fat bit and how much you should have on Keto. I have the carbs and protein done pat......

Keto has probably a bit more fat than original Atkins.
Do you measure and monitor what you eat or do you just "go for it"?
The reason I ask is that if you have some meal data its easier to make suggestions as to tweaks.
Otherwise to up the fats - have fattier cuts pork belly, chicken thighs, steaks, bacon rather than lean.
Melt some butter over meat and veg (if you have those)
I have cream in coffee rather than milk (and tea sometimes too) .
Avocado are great sources of fat over protein and carbs.

 

[Moggely]

You know@bulkbiker now that i have you here this is a tipocal days food for me So maybe you can tell me if it's Keto I have looked it up but anyway here goes. Breakfast. usually bacon and eggs, mushrooms. Sometimes scrambled or poached cooked in butter. Nothing during the day only tea water and so on Breakfast at 10am. Meal at night at 6 or 7 pm is usually meat of some sort with cauliflower mash and i stalk of broccoli or 2 small Brussels sprouts with butter. I think I'm having trouble with not getting enough fats. Sometimes avocado half and coconut oil almond nuts just a few. Haven't tried the bullet coffee yet so that will be a challenge.

 

[bulkbiker]

You know@bulkbiker now that i have you here this is a tipocal days food for me So maybe you can tell me if it's Keto I have looked it up but anyway here goes. Breakfast. usually bacon and eggs, mushrooms. Sometimes scrambled or poached cooked in butter. Nothing during the day only tea water and so on Breakfast at 10am. Meal at night at 6 or 7 pm is usually meat of some sort with cauliflower mash and i stalk of broccoli or 2 small Brussels sprouts with butter. I think I'm having trouble with not getting enough fats. Sometimes avocado half and coconut oil almond nuts just a few. Haven't tried the bullet coffee yet so that will be a challenge.

Sounds pretty keto to me although not very much food.. 2 brussels sprouts? I used to have about 20.. with lots of butter and salt and pepper. I don't have BPC just double cream in my coffee. Think you are doing fine. How are your bloods on that regime?

 

[Moggely]

Thanks@bulkbiker. Well my bloods started at 11.4 Late February when i was diagnosed so started Well Keto immediately and 2 and half months later was 5.8 fast forward to now have about another month to go for test but really hoping it's lower i saw from your profile you are a fan of Doctor Fung and ultra lchf i have watched his videos and for me it's working. I think your right about the vege thing though as my husband says I'm not eating much but I'm rarely hungry. Cholesterol first time in my life is really good but the doc is looking towards statins which is just not on the agenda . So maybe i need to look into the more veges. Have to admit i lost 3 stone all up so something is working. What BPC? Oh never mind it means bullet proof coffee.

 

[Oldvatr]

Keto has probably a bit more fat than original Atkins.
Do you measure and monitor what you eat or do you just "go for it"?
The reason I ask is that if you have some meal data its easier to make suggestions as to tweaks.
Otherwise to up the fats - have fattier cuts pork belly, chicken thighs, steaks, bacon rather than lean.
Melt some butter over meat and veg (if you have those)
I have cream in coffee rather than milk (and tea sometimes too) .
Avocado are great sources of fat over protein and carbs.

Could we please move these diet topics to a different thread. They are irrelevant to the OP, and it is distracting us from discussing a serious subject for those using sulfonyl medication.