Journal ArticleDOI
Cardiovascular safety of sulfonylureas: a meta-analysis of randomized clinical trials.
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TLDR
Cardiovascular safety of sulfonylurea has been questioned by some authors and all available data on this issue from randomized trials is collected.Abstract:
Aim
Cardiovascular safety of sulfonylurea has been questioned by some authors. This article aims at collecting all available data on this issue from randomized trials.
Methods
A meta-analysis was performed including all trials with a duration of at least 6 months, comparing a sulfonylurea with a non-sulfonylurea agent in type 2 diabetes. Major cardiovascular events (MACE) and mortality were retrieved and combined to calculate Mantel-Haenzel odds ratio (MH-OR).
Results
Of the 115 selected trials, 62 reported information on MACE, and 30 reported at least one event. MH-OR for sulfonylurea was 1.08 [0.86–1.36], p = 0.52 (1.85 [1.20–2.87], p = 0.005, in the five trials vs. DPP4 inhibitors, no significant differences vs. other comparators). The MH-OR for myocardial infarction and stroke was 0.88 [0.75–1.04], p = 0.13 and 1.28 [1.03–1.60], p = 0.026, respectively. Mortality was significantly increased with sulfonylureas (MH-OR: 1.22 [1.01–1.49], p = 0.047).
Conclusions
In type 2 diabetes, the use of sulfonylureas is associated with increased mortality and a higher risk of stroke, whereas the overall incidence of MACE appears to be unaffected. Significant differences in cardiovascular risk could be present in direct comparisons with specific classes of glucose-lowering agents, such as DPP4 inhibitors, but this hypothesis needs to be confirmed in long-term cardiovascular outcomes trials. The results of this meta-analysis need to be interpreted with caution, mainly because of limitations in trial quality and under-reporting of information on cardiovascular events and mortality. However, the cardiovascular safety of sulfonylureas cannot be considered established unless it is evaluated in long-term cardiovascular outcomes trials.read more
Citations
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Alogliptin after Acute Coronary Syndrome in Patients with Type 2 Diabetes
William B. White,Christopher P. Cannon,Simon Heller,Steven E. Nissen,Richard M. Bergenstal,George L. Bakris,Alfonso Perez,Penny R. Fleck,Cyrus R. Mehta,Stuart Kupfer,Craig A. Wilson,William C. Cushman,Faiez Zannad +12 more
TL;DR: Among patients with type 2 diabetes who had had a recent acute coronary syndrome, the rates of major adverse cardiovascular events were not increased with the DPP-4 inhibitor alogliptin as compared with placebo.
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Nisa M. Maruthur,Eva Tseng,Susan Hutfless,Lisa M Wilson,Catalina Suarez-Cuervo,Zackary Berger,Yue Chu,Emmanuel Iyoha,Jodi B Segal,Shari Bolen +9 more
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Drug-induced mitochondrial dysfunction and cardiotoxicity.
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TL;DR: The vast majority of patients with T2DM have multiple comorbidities, and the presence of multimorbidity should be considered in the context of clinical decision making.
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TL;DR: Firm evidence that in T2DM cardiovascular disease can be reversed or prevented by improving glycaemic control is still incomplete and must await large, long-term clinical trials in patients at low risk using modern treatment strategies, i.e., drug combinations designed to maximize HbA1c reduction while minimizing hypoglycaemia and excessive weight gain.
References
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Journal ArticleDOI
Comparison Between Repaglinide and Glimepiride in Patients with Type 2 Diabetes Mellitus: A One-Year, Randomized, Double-Blind Assessment of Metabolic Parameters and Cardiovascular Risk Factors
TL;DR: Repaglinide and glimepiride improved glycemic control and reduced levels of other metabolic parameters of interest in this population of patients with type 2 diabetes mellitus.
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TL;DR: It is concluded that exenatide was better than glimepiride in improving insulin resistance and inflammatory state and adiponectin increase, and tumor necrosis factor-α reduction seem to be related to weight loss obtained with exen atide.
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Metformin-glibenclamide versus metformin plus rosiglitazone in patients with type 2 diabetes inadequately controlled on metformin monotherapy
TL;DR: This double‐blind study evaluated the efficacy and safety of metformin‐glibenclamide tablets vs. meetformin plus rosiglitazone therapy in patients with type 2 diabetes inadequately controlled on met formin monotherapy.
Journal ArticleDOI
Glyburide or Insulin for Metabolic Control in Non-Insulin-Dependent Diabetes Mellitus: A Randomized, Double-Blind Study
TL;DR: In this article, the authors compared the relative efficacy, risks, and benefits of insulin with glyburide in achieving normoglycemia in non-insulin-dependent diabetes mellitus.
Journal ArticleDOI
Effects of pioglitazone and glimepiride on glycemic control and insulin sensitivity in Mexican patients with type 2 diabetes mellitus: A multicenter, randomized, double-blind, parallel-group trial
M. H. Tan,Don Johns,Guillermo González Gálvez,Oscar Antúnez,Guadalupe Fabián,Fernando Flores-Lozano,Sergio Zúñiga Guajardo,Eduardo Garza,Hector Morales,Christopher S Konkoy,Matthias Herz +10 more
TL;DR: It is suggested that long-term treatment with pioglitazone enhances insulin sensitivity relative to glimepiride in Mexican patients with type 2 diabetes and that piog litazone may have a more sustained antihyperglycemic effect.
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