January 3, 2013
Sulfonylureas May Increase Cardiovascular Events
Sulfonylureas seem to be coming under more scrutiny lately. This is apparently justified on several fronts because of changes that have alerted researchers of some very real problems. Many of these problems were not part of the requirements or perceived requirements when the drugs were originally approved by the Food and Drug Administration.
Gretchen Becker wrote about this class of drugs causing pancreas fatigue and decline of the functionality of these drugs when used for extended periods. While I am a believer of this, this discussion is still controversial and more research is needed to prove this beyond argument. I am one of the fortunate people because of my allergy so this is not something I need to concern myself with in my lifetime. This was also the reason that I suspect my doctor was so willing to move me to insulin when the oral medications were not helping manage my blood glucose levels.
Recently, another concern has been brought to the front. The American Diabetes Association stated that sulfonylurea drugs are insulin-production stimulants that have been in use since the 1950s. Metformin, also dating to the 1950s, works by lowering blood glucose levels by reducing the quantity of glucose entering the blood. A recent multi-year study published in the Nov. 6 issue of the journal Annals of Internal Medicine found that sulfonylurea use was associated with a 21 percent increased risk of acute myocardial infarction, stroke, or death.
For comparison purposes to determine the impact of the two drugs on cardiovascular results, a pool of more than 250,000 veterans over the age of 18 was used. No average age of the study is given and none of the participants had any serious medical complications other than diabetes at the start. Almost 100,000 were placed on a standard regimen of sulfonylurea therapy, while slightly over 155,000 took metformin.
The authors stated that their observations were consistent with previous indications that metformin is associated with fewer serious heart issues than sulfonylureas. Even with this, the researchers stated that the findings suggest metformin should be the oral treatment of choice. They did stress more testing is needed to determine if their findings would apply to women or other racial and ethnic groups since 97 percent of their study participants were men and 75 percent were white.
While the findings pointing to this situation have probably been there for several decades the U.S. Food and Drug Administration did not require testing for cardiovascular outcomes when looking at diabetes drugs until very recently.
The drugs used for the study include for metformin, the brand names of Glucophage and Fortamet (or Glucophage XR). The drugs used for sulfonylureas include glyburide (brand name - DiaBeta) and glipizide (brand name - Glucotrol). No other sulfonylureas were mentioned, therefore, we cannot know if the others are more or less likely to cause cardiovascular problems.