Popular Diabetes Drugs Tied to Heart Failure
Study Shows Sulfonylureas Have Higher Heart Failure Risk Than Metformin
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.
"A decade ago it was something of a toss-up as to whether a new patient would be given metformin or a sulfonylurea," he tells WebMD. "But metformin has earned the right to be the first-line oral drug."
The bigger issue, he says, is whether aggressive glucose control is really as important as has been widely believed in managing type 2 diabetes.
Bergenstal is executive director of the International Diabetes Center in Minneapolis, Minn.
"Recent studies have failed to confirm that glucose control really benefits the heart," he says. "And since 80% of diabetes deaths are heart related, it is clear that controlling cardiovascular risk factors like blood pressure and cholesterol should be a major focus."
Bergenstal says that a sulfonylurea may still be a good option for individual patients who can't take metformin or need additional medication. Patients and their doctors have to weigh individual risks and benefits.
No one should stop taking their medications based on this study, Tzoulaki tells WebMD.