Sulfonylureas as second line therapy for type 2 diabetes among veterans: Results from a National Longitudinal Cohort Study.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: England NLM ID: 101463825 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1878-0210 (Electronic) Linking ISSN: 18780210 NLM ISO Abbreviation: Prim Care Diabetes Subsets: MEDLINE
    • Publication Information:
      Original Publication: Kidlington, Oxford : Elsevier
    • Subject Terms:
      Diabetes Mellitus, Type 2*/diagnosis ; Diabetes Mellitus, Type 2*/drug therapy ; Diabetes Mellitus, Type 2*/epidemiology ; Veterans* ; Metformin*/adverse effects ; Hypoglycemia*/chemically induced ; Hypoglycemia*/epidemiology ; Hypoglycemia*/complications; Aged ; Humans ; United States/epidemiology ; Hypoglycemic Agents/adverse effects ; Retrospective Studies ; Longitudinal Studies ; Medicare ; Sulfonylurea Compounds/adverse effects ; Cohort Studies
    • Abstract:
      Aims: To assess if switching to or adding sulfonylureas increases major adverse cardiovascular events (MACE) or severe hypoglycemia versus remaining on metformin alone.
      Materials and Methods: This was a retrospective, longitudinal cohort utilizing United States Veterans Health Administration and Medicare data. Veterans with type 2 diabetes on metformin monotherapy between 2004 and 2006 were identified. Follow-up occurred through 2016. Those treated with either metformin plus a second-generation sulfonylurea (N = 45,305) or converted from metformin to a second-generation sulfonylurea (N = 2813) were compared to those receiving metformin monotherapy (N = 65,550). Hazard ratios (HR) and 95%CI from longitudinal competing risk Cox models were used to measure the association between sulfonylureas and outcomes.
      Results: Switching to or adding a sulfonylurea to metformin was associated with 3 times the risk of severe hypoglycemia versus metformin monotherapy (HR:3.44, 95% CI: 3.06,3.85 and HR: 3.08, 95% CI: 2.77,3.42, respectively). Switching to or adding a sulfonylurea to metformin was associated with a 7-19% higher risk of MACE versus metformin monotherapy (HR: 1.07, 95% CI: 1.00,1.14 and HR: 1.19, 95% CI: 1.13,1.25, respectively).
      Conclusions: Switching to and adding second-generation sulfonylureas was associated an increase in severe hypoglycemia and MACE versus remaining on metformin alone. In an era where guidelines recommend diabetes therapies based on compelling indications, safety outcomes should be a key consideration when selecting therapy.
      Competing Interests: Declaration of Competing Interest D Taber has received grants from Merck, Veloxis, CareDx and is on an advisory board for Veloxis and Eurofins. None of these relationships are relevant to this manuscript. This work represents the views of the authors and not those of the Medical University of South Carolina (MUSC) or Veteran Health Administration (VHA).
      (Published by Elsevier Ltd.)
    • Contributed Indexing:
      Keywords: Acute coronary syndrome; Adverse drug event; Glycemic control; Medication safety; Myocardial infarction
    • Accession Number:
      0 (Hypoglycemic Agents)
      0 (Sulfonylurea Compounds)
      9100L32L2N (Metformin)
    • Publication Date:
      Date Created: 20230430 Date Completed: 20230801 Latest Revision: 20230801
    • Publication Date:
      20231215
    • Accession Number:
      10.1016/j.pcd.2023.04.006
    • Accession Number:
      37121788