Type-2 Diabetics Treated Only With Sulfonylureas May Be at Risk
Further evidence supports a multi-therapy approach that also includes metformin
--by Joann Jovinelly
Sulfonylureas are a class of drugs used to increase the release of insulin from beta cells in the body’s pancreas. They are used to treat or correct hyperglycemia, or elevated blood sugar. They have been used successfully since the 1950s as a single drug therapy or in combination with other drugs to treat type-2 diabetes.
The problem with sulfonylureas is that they can also cause side effects, including increased blood pressure, weight gain, abdominal upset, chronic headaches, and, according to a new study, an increased risk of heart attack, stroke, and death.
Although the exact reason for this increased risk remains unknown, study author Dr. Christianne Roumie, an internist with Vanderbilt University Medical Center in Nashville, Tennessee, has been examining the use of sulfonylureas for years. Although this most recent study does not shed new light on why the drugs might be more harmful for some type-2 diabetics, Roumie suggests that public health advocates sponsor a randomized controlled trial to provide more evidence of the cardiovascular risks associated with their use.
Physicians have been aware of the increased cardiovascular risks of sulfonylureas for roughly the past decade.
Source and Method
For the 2012 study, Roumie’s team examined data from more than 250,000 veterans who sought treatment for type-2 diabetes and compared outcomes for those taking only sulfonylureas versus those taking sulfonylureas along with other drugs, such as metformin.
Though researchers could not determine whether sulfonylureas were harmful on their own or whether metformin acted as a preventative when the two were taken in combination, type-2 diabetics taking sulfonylureas alone experienced a 21 percent increase in cardiac events, such as heart attack, stroke, or death.
A 2009 study published in the British Medical Journal produced similar results. In that study, researchers examined more than 90,000 type-2 diabetics over a 15-year period. They found that compared to those patients taking metformin, “monotherapy with first or second-generation sulfonylureas was associated with a 24 to 61 percent increase in mortality, with up to a 30 percent increase in congestive heart failure.”
As most people understand, all drugs produce unwanted side effects. And while most are typically minor compared to the drugs' overall benefits, type-2 diabetes remains one of the most challenging conditions to effectively treat. People are often lax about controlling their blood glucose levels with diet and exercise, and many may not test their blood sugar levels regularly.
If your doctor suggests taking a sulfonylurea drug on its own, discuss your concerns and whether or not your heart is healthy. Go over all of your risk factors for heart disease, including high blood pressure, excessive weight and body mass (especially around the waist), and if you’ve experienced chest pain. Stress levels and whether or not you have symptoms of sleep apnea should also be considered. Adding metformin along with your sulfonylurea drug may be an easy—and proactive—approach to more effectively treating type-2 diabetes.