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Two Commonly Prescribed Type 2 Diabetes Drugs Raise Risk For Heart Attack

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Two drugs that doctors commonly prescribe for patients with type 2 diabetes carry an increased risk of cardiovascular events such as stroke, heart attack, heart failure, and even amputation.

Sulfonylureas And Basal Insulin

Matthew O'Brien, from Northwestern University Feinberg School of Medicine, warned diabetes patients to be aware of medications they take in case these could lead to serious cardiovascular issues.

Doctors commonly prescribe the two drugs sulfonylureas and basal insulin to patients who have taken the widely used type 2 diabetes metformin but need second-line drugs because metformin alone did not work by itself or it was not tolerated.

O'Brien and colleagues found that 60 percent of type 2 diabetes patients in the United States who need a second-line medication are prescribed one of these two drugs.

By looking at the data of 132,737 patients with type 2 diabetes, they also found that these patients face higher cardiovascular risk.

Those who take sulfonylureas are 60 percent more likely to experience cardiovascular harm compared with those taking a newer class of diabetes drugs called DPP-4 inhibitors. Those who take basal insulin, on the other hand, are twice as likely to experience cardiovascular events than those prescribed the new drugs.

"According to our findings, we only have to prescribe basal insulin to 37 people over two years to observe one cardiovascular event, such as a heart attack, stroke, heart failure or amputation," O'Brien said.

"For sulfonylureas, that number was a bit higher — 103 people. But when you apply these numbers to 30 million Americans with diabetes, this has staggering implications for how we may be harming many patients."

New Class Of Diabetes Drugs

The researchers said that doctors should prescribe newer class of diabetes medications more routinely after metformin instead of prescribing sulfonylureas or basal insulin.

These drugs include GLP-1 agonists such as liraglutide, DPP-4 inhibitors (e.g. sitagliptin), and SGLT-2 inhibitors (e.g. empagliflozin).

"Among insured adult patients with type 2 diabetes initiating second-line ADM therapy, the short-term cardiovascular outcomes of GLP-1 receptor agonists, SGLT-2 inhibitors, and DPP-4 inhibitors were similar. Higher cardiovascular risk was associated with use of sulfonylureas or basal insulin compared with newer ADM classes," the researchers wrote in their study.

The findings were published in JAMA Network Open on Dec. 21.

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