Skip to content
My WebMD Sign In, Sign Up

Diabetes Health Center

Font Size
A
A
A

Popular Diabetes Drugs Tied to Heart Failure

Study Shows Sulfonylureas Have Higher Heart Failure Risk Than Metformin
By
WebMD Health News
Reviewed by Louise Chang, MD

heart_risk_of_diabetes_drugs_1.jpg

Dec. 4, 2009 -- Concerns that the diabetes drugs Avandia and Actos raise the risk for heart failure led the FDA to require label changes warning of the potential risk two years ago.

Now a new study suggests this concern might be unfounded, but it also raises questions about a different class of oral diabetes drugs that have been used since the 1950s: sulfonylureas.

Researchers reported that diabetes patients who used sulfonylureas had a higher risk of death from all causes and a higher risk of heart failure than diabetes patients who used the most widely prescribed diabetes drug, metformin.

Compared with metformin, also known as Glucophage, single-drug treatment with first- and second-generation sulfonylureas was associated with up to a 61% increased risk for death. Users of second-generation sulfonylureas had up to a 30% higher risk for congestive heart failure.

Patients treated with Actos or Avandia did not appear to have a greater risk for heart attacks than those treated with metformin.

Treating Diabetes

As many as 180 million people worldwide have type 2 diabetes, and heart attacks and heart failure are among the major killers associated with the disease.

Over the past two decades, a host of drugs have been approved to treat diabetes. The drugs improve blood sugar control, but there have also been concerns that some may raise the risk of cardiovascular events in people who are already at high risk.

In an effort to explore the issue, researchers in the U.K. examined the treatment records of more than 91,000 diabetes patients enrolled in a national database between 1990 and 2005.

During the follow-up, almost 36,000 patients had heart attacks, 6,900 developed congestive heart failure, and just over 18,500 died.

Metformin was the most widely prescribed drug, followed by second-generation sulfonylureas. Many patients took more than one diabetes drug.

Among the major findings:

  • Compared with metformin, single-drug treatments with first- or second-generation sulfonylureas was associated with a 24% to 61% increased risk for death from all causes. 
  • Compared to metformin, second-generation sulfonylurea use was associated with an 18% to 30% increased risk for heart failure. 
  • Compared to metformin, treatment with Actos was associated with a 31% to 39% decreased risk for death.

Metformin as a First-Line Treatment

First-generation sulfonylureas in this study include the drugs acetohexamide (Dymelor), chlorpropamide (Diabinese), tolbutamide, and tolazamide (Tolinase).

Second-generation versions from the study include glipizide (Glucotrol), gliclazide, glimepiride (Amaryl), and glyburide (Diabeta, Micronase, Glycron, Glynase).

Study researcher Ionna Tzoulaki, PhD, of the Imperial College London, tells WebMD the findings are consistent with current recommendations by the American Diabetes Association (ADA) and other diabetes groups designating metformin as the first-line oral treatment for type 2 diabetes.

ADA president-elect for medicine and science Richard M. Bergenstal, MD, agrees.

Is This Normal? Get the Facts Fast!

Check Your Blood Sugar Level Now
What type of diabetes do you have?
Your gender:

Get the latest Diabetes newsletter delivered to your inbox!


or
Answer:
Low
0-69
Normal
70-130
High
131+

Your level is currently

If the level is below 70 and you are experiencing symptoms such as shaking, sweating or difficulty thinking, you will need to raise the number immediately. A quick solution is to eat a few pieces of hard candy or 1 tablespoon of sugar or honey. Recheck your numbers again in 15 minutes to see if the number has gone up. If not, repeat the steps above or call your doctor.

People who experience hypoglycemia several times in a week should call their health care provider. It's important to monitor your levels each day so you can make sure your numbers are within the range. If you are pregnant always consult with your health care provider.

Congratulations on taking steps to manage your health.

However, it's important to continue to track your numbers so that you can make lifestyle changes if needed. If you are pregnant always consult with your physician.

Your level is high if this reading was taken before eating. Aim for 70-130 before meals and less than 180 two hours after meals.

Even if your number is high, it's not too late for you to take control of your health and lower your blood sugar.

One of the first steps is to monitor your levels each day. If you are pregnant always consult with your physician.

Did You Know Your Lifestyle Choices
Affect Your Blood Sugar?

Use the Blood Glucose Tracker to monitor
how well you manage your blood sugar over time.

Get Started

This tool is not intended for women who are pregnant.

Start Over

Step:  of 

Today on WebMD

Woman holding cake
Slideshow
feet
Slideshow
 
man organizing pills
Slideshow
Close up of eye
Slideshow
 

Woman serving fast food from window
Video
Can Vinegar Treat Diabetes
Video
 
Middle aged person
Tool
are battery operated toothbrushes really better
Video
 

Prediabetes How to Prevent Type 2 Diabetes
Article
type 2 diabetes
Slideshow
 
food fitness planner
Tool
Are You at Risk for Dupuytrens Contracture
Article
 

WebMD Special Sections