Mortality and cardiovascular risk associated with different insulin secretagogues compared with metformin in type 2 diabetes, with or without a previous myocardial infarction: a nationwide study
Key result
Insulin secretagogue monotherapy linked to ~32% higher all-cause mortality compared with metformin in T2D.
- HR 1.32
- 95% CI 1.24-1.40
- n=107,806
Why the study?
Do different insulin secretagogues compared with metformin affect mortality and cardiovascular risk in patients with type 2 diabetes with or without previous myocardial infarction?
Population
107,806 Danish residents >20 years of age with type 2 diabetes initiating single-agent insulin secretagogues…
Comparison
Single-agent insulin secretagogues vs Metformin monotherapy
Design
Cohort
Follow-up
up to 9 years (median 3.3 years)
Authors
Discussion
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Implication
Monotherapy with most insulin secretagogues is associated with increased mortality and cardiovascular risk compared with metformin, though gliclazide and repaglinide appear to have a lower risk profile similar to metformin.
Key Points
- This study aims to assess the long-term mortality and cardiovascular risks of insulin secretagogues compared to metformin in type 2 diabetes.
- Nationwide study in Denmark with >20-year-old residents initiating either insulin secretagogues or metformin between 1997 and 2006.
- Follow-up period was up to 9 years, with median follow-up of 3.3 years using individual-level linkage of national registers.
- Multivariable Cox proportional-hazard analyses and propensity analyses were used to evaluate all-cause and cardiovascular mortality.
- All-cause mortality was higher for glimepiride (HR 1.32, 95% CI 1.24-1.40) compared to metformin in patients without previous MI.
- In patients with previous MI, gliblenclamide had HR 1.47 (95% CI 1.22-1.76) showing even higher risk.
- Gliclazide and repaglinide not significantly different from metformin for both all-cause and cardiovascular mortality.
Study Design
Type
Cohort (n=107,806)
Multicenter
Yes
Structured PICO
Do different insulin secretagogues compared with metformin affect mortality and cardiovascular risk in patients with type 2 diabetes with or without previous myocardial infarction?
P
Population
107,806 Danish residents >20 years old with type 2 diabetes initiating single-agent insulin secretagogues or metformin, followed for a median of 3.3 years.
E
Exposure
Single-agent insulin secretagogues (glimepiride, glibenclamide, glipizide, tolbutamide, gliclazide, or repaglinide)
C
Comparator
Metformin monotherapy
O
Outcome
All-cause mortalityhard clinical
Main Result
Hazard Ratio: 1.32 (95% CI 1.24–1.4)
Monotherapy with most insulin secretagogues is associated with increased mortality and cardiovascular risk compared with metformin, though gliclazide and repaglinide appear to have a lower risk profile similar to metformin.
Cite This Study
Schramm et al. (2011) conducted a cohort in Type 2 diabetes (n=107,806). Insulin secretagogues vs. Metformin was evaluated on All-cause mortality (HR 1.32, 95% CI 1.24-1.40). Monotherapy with most insulin secretagogues, such as glimepiride (HR 1.32; 95% CI 1.24-1.40), was associated with increased all-cause mortality compared with metformin in type 2 diabetes.