Cardiovascular Safety in Type 2 Diabetes With Sulfonylureas as Second-line Drugs: A Nationwide Population-Based Comparative Safety Study
Authors' conclusion
Our findings contribute to the understanding that second-line SU for glucose lowering are unlikely to increase CV risk or all-cause mortality. Given their potent efficacy, microvascular benefits, cost effectiveness, and widespread use, this study supports that SU should remain a part of the global diabetes treatment portfolio.
Study context
- Population
- People with T2D diagnosed in Scotland before 31 December 2017 who failed to reach HbA1c 48 mmol/mol on metformin monotherapy and initiated second-line sulfonylureas (SU)/DPP4i/thiazolidinediones (TZD) on or after 1 January 2010
- Exposure
- SU vs non-SU as second-line therapy
- Outcome
- Major adverse cardiovascular events (MACE): hospitalization for MI, ischemic stroke, HF, and cardiovascular (CV) death
Methodological detailsnationwide, multivariable Cox proportional hazards regression, instrumental variable approach
- Nationwide
- Multivariable Cox proportional hazards regression
- Instrumental variable approach
Main finding
As reported in the abstract
MACE
SU vs non-SUHazard ratio (95% CI)
Multivariable Cox regression
1.00(0.91–1.09)
IV analysis 1
1.02(0.91–1.13)
IV analysis 2
1.03(0.91–1.16)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR (CI) | |
|---|---|---|
| All-cause deathSUvs non-SUCox regression | 1.03 (0.94–1.13) | |
| All-cause deathSUvs non-SUIV analysis 1 | 1.04 (0.93–1.17) | |
| All-cause deathSUvs non-SUIV analysis 2 | 1.03 (0.90–1.17) | |
| 0.512Hazard ratio (log scale) |
Original publication
Cardiovascular Safety in Type 2 Diabetes With Sulfonylureas as Second-line Drugs: A Nationwide Population-Based Comparative Safety Study. Diabetes Care. Published 21 March 2023. doi:10.
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