Article Title:

Risk of mortality and adverse cardiovascular outcomes in type 2 diabetes: a comparison of patients related with sulfonylureas and metformin.

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Diabetologia. 2006 May; 49(5):930-6 Epub 2006 Mar 9.


Evans JM, Ogston SA, Emslie-Smith A, Morris AD.


The aim of this study was to evaluate the risk of adverse cardiovascular outomes in patients with type 2 diabetes newlytreated with sulfonylureas and metformin.


The Diabetes Audit and Research in Tayside, Scotland (DARTS) diabetes informaion system and the Medicines Monitoring Unit (MEMO) dispensed precribing database for the population of Tayside, Scotland (400,000 people) were employed. Patients newly prescribed with oral hypoglycaemic agents between 1994 and 2001 were classified into 5 study cohorts according to the treatment recieved: metformin only, sulfonylureas, and both drugs simultaneously, In Cox regression analyses, we estimated relative risks for all-cause mortality, cardiovascular mortality and cardiovascular hospital admission for patients in the five study cohorts, with metformin monotherapy as the reference group.


Of the 5,730 study patients, 1,000 died during a maximum of 8 years follow-up. Patients in the sulfonylureas only cohort had increased risks of mortality and cardiovascular mortality, with unadjusted relative risks of 3.12 (95% CI 2.54-3.84) and 3.71 (95% CI 2.64-5.22), respectivley. After adjusting for differences between groups (age, sex, duration of diabetes, blood pressure, cholesterol, HbA(1c) smoking, previous hospital admission, treatment with cardiovascular medication) these relative risks were 1.43 (95% CI 1.15-1.77) and 1.70 (95% CI 1.18-2.45), respectivley. Patients in the combination cohorts had significantly increased risks of cardiovascular hospital admission, as well as increased risks of mortality and cardiovascular mortality.


In this cohort study of patients newly treated with oral hypoglycaemic agents, those treated with sulfonylureas only, or combinations of sulfonylureas and metformin, were at higher risk of adverse cardiovascular outcomes than those treated with metformin alone.

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