Metformin Outperforms Common Class of Diabetes Drugs in Study

SUNDAY, June 24 (HealthDay News) — Three widely used diabetes
drugs are associated with a greater risk of death when compared to a
popular drug from a different class, metformin, according to a new
study.

Researchers analyzed data from nearly 24,000 patients with type 2
diabetes, average age 62, who were treated with one of three drugs called
sulfonylureas (glipizide, glyburide, and glimepiride) or with another type
of drug called metformin.

Sulfonylureas help decrease blood sugar levels by stimulating the
pancreas to produce insulin. Metformin also helps reduce blood sugar
levels.

Overall, all three sulfonylureas were associated with a more than 50
percent greater risk of death compared to metformin, according to the
study, which was funded by drug company Astra Zeneca.

The researchers also found that, among diabetes patients with heart
disease, glipizide was associated with a 41 percent greater risk of death
and glyburide was associated with a 38 percent greater risk of death,
compared with glimepiride and metformin.

According to one expert not connected to the study, the new data could
provide some guidance for patients.

“Patients taking sulfonylureas should be made aware of this increased
risk of death and other oral options for glycemic [blood sugar] control
should be discussed,” said Dr. Spyros Mezitis, an endocrinologist at Lenox
Hill Hospital in New York City.

The study was to be presented Sunday at The Endocrine Society’s annual
meeting in Houston.

“We have clearly demonstrated that metformin is associated with a
substantial reduction in mortality risk, and, thus, should be the
preferred first-line agent, if one has a choice between metformin and a
sulfonylurea,” said study author Dr. Kevin M. Pantalone, an
endocrinologist at Summa Western Reserve Hospital in Cuyahoga Falls,
Ohio.

He conducted the study with a team of researchers from Cleveland
Clinic.

Another expert said the study may have “enormous clinical
implications.”

Dr. Minisha Sood, also an endocrinologist at Lenox Hill, said that
sulfonylureas may fare worse than metformin because the former might
“interfere” with cardiovascular processes that strengthen and protect
heart tissue so it becomes more resilient should a cardiac event
occur.

“What’s interesting about this study is that all three sulfonylureas
examined led to increased mortality rates vs. metformin in the entire
cohort study, which included patients without coronary artery disease,”
Sood added. “Does this mean that we shouldn’t be prescribing sulfonylureas
at all? I think prospective trials are needed to answer that question, so
the jury is still out.”

Nearly 26 million people in the United States have diabetes, according
to the U.S. Centers for Disease Control and Prevention. Many of these
patients also have other health problems, including heart disease.

Findings presented at medical meetings are typically considered
preliminary until published in a peer-reviewed journal.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney
Diseases has more about diabetes medicines.

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