Metformin outperforms sulphonylureas for lowering risks of heart disease, a new analysis shows

Camille Bienvenu
Wed, 20 Apr 2016
Metformin outperforms sulphonylureas for lowering risks of heart disease, a new analysis shows
A new analysis of 204 studies finds that metformin is more successful in reducing heart disease in type 2 diabetes patients than other drugs, including sulphonylureas.

The study, conducted by researchers at The John Hopkins University School of Medicine, included 179 randomised trials and 25 observational studies – and involved 1,4 million people.

The researchers assessed the efficacy and safety of more than a dozen FDA-approved blood sugar-lowering therapy agents for type 2 diabetics, such as thiazolidinediones, sulphonylureas, dipeptidyl peptidase (DPP)-4 inhibitors, sodium glucose cotransporter (SGLT)-2 inhibitors, glucagon-like peptide-1 receptor agonists and metformin.

They found that the latter and most prescribed drug metformin had greater impact on cardiovascular morbidity when used both alone and in combination with other medication.

Compared to sulphonylureas, metformin reduced the risk of suffering from heart attacks and strokes - major diabetes-related complications associated with uncontrolled blood sugar after blindness, kidney failure and amputations – by about 30 to 40 per cent.

In the study, described in the April 19 issue of the Annals of Internal Medicine, researchers presents metformin as a clear winner for the management of type 2 diabetes.

The lead author on the meta-analysis, Dr. Nisa M. Maruthur, explained that these findings are a big step up with regards to diabetes medication. Up until now, no drug seemed to stand out at reducing cardiovascular fatalities in people with uncontrolled blood sugar.

His review provides a much awaited update to a 2011 study investigating the effectiveness of various blood sugar-lowering monotherapies, in which time several new drugs have since come on the market. Among them is the relatively new at the time DPP-4 inhibitors.

Most of the 204 studies were short term (no more than two years) and conducted across Europe, Asia and the United States in young to middle-aged participants that were generally overweight with very high and unsteady blood sugar levels and without any other significant health problems.

Other common drug effects looked at in the analysis include hypoglycemia, gastrointestinal problems and weight gain, the latter (up to 5kg) according to the study, being more frequently observed in patients treated with sulphonylureas, thiazolidinediones and insulin. Sulphonylureas are also associated with an elevated risk of hypoglycemia, but do not increase gut issues, which are largely attributed to metformin and GLP-1 receptor agonists.

Overall, the new findings of this study correlate the current recommendation that metformin, around since the late 1990s, be the first-line therapy for type 2 diabetes.
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