Douros A, et al. - This study investigated the differential impacts of sulfonylureas, grouped according to pancreas specificity and duration of action, on the risks of acute myocardial infarction, ischemic stroke, cardiovascular death, all-cause mortality, and severe hypoglycemia. Compared with the specific, short-acting sulfonylureas gliclazide, glipizide, and tolbutamide, the nonspecific, long-acting sulfonylureas glyburide and glimepiride did not have an increased risk of cardiovascular adverse events despite having an increased risk of severe hypoglycemia.

Methods

• Researchers performed a cohort study among patients with type 2 diabetes initiating monotherapy with sulfonylureas between 1998 and 2013, using the U.K. Clinical Practice Research Datalink, linked with the Hospital Episodes Statistics and the Office for National Statistics databases.
• They estimated adjusted hazard ratios (HRs) and 95% CIs using Cox proportional hazards models, comparing use of pancreas-nonspecific, long-acting sulfonylureas (glyburide/glimepiride) to pancreas-specific, short-acting sulfonylureas (gliclazide/glipizide/tolbutamide).

Results

• The cohort included 17,604 sulfonylurea initiators (mean [SD] follow-up 1.2 [1.5] years).
• Researchers observed that compared with specific, short-acting sulfonylureas (15,741 initiators), nonspecific, long-acting sulfonylureas (1,863 initiators) were not associated with an increased risk of acute myocardial infarction (HR 0.86; CI 0.55–1.34), ischemic stroke (HR 0.92; CI 0.59–1.45), cardiovascular death (HR 1.01; CI 0.72–1.40), or all-cause mortality (HR 0.81; CI 0.66–1.003), but with an increased risk of severe hypoglycemia (HR 2.83; CI 1.64–4.88).