Basal Insulin, Sulfonylureas Linked With Increased Heart Risks: Study

Certain classes of commonly used type 2 diabetes medications may increase an individual’s risk of developing cardiovascular problems, according to the findings of a new study. 

Researchers with the Northwestern University Feinberg School of Medicine published a study in the medical journal JAMA Network Open on December 21, reporting that older diabetes drugs that are commonly prescribed by doctors, and typically used in combination with Metformin, may increase a person’s risk of having a heart attack or stroke.

The study involved a review of data on nearly 133,000 adults with type 2 diabetes who started a second line diabetes medication after taking either Metformin or having taken no diabetes treatment.

Newer, second line diabetes medications included in the study were glucagon-like peptide 1 receptor agonists (GLP-1) like Byetta and Trulicity; dipeptidyl peptidase 4 inhibitors (DPP-4) like Tradjenta and Januvia; and sodium-glucose con transporter 2 inhibitors (SGLT-2) like Invokana and Farxiga.

Those were compared to older second line diabetes medications including sulfonylureas medications like Diabinese, Amaryl, Glucotrol, Diabeta and basal insulins like Lantus, Toujeo, Levemir, and Tresiba.

Researchers found the newer medications, like Trulicity, Januvia, and Invokana were linked to a 20% reduction in the risk of cardiovascular complications like heart disease and stroke.

The older classes of medications, including drugs like Diabeta and Tresiba, increased the users risk of heart problems. Patients taking sulfonylureas drugs had a 36% increased risk of heart problems. Those taking base insulin drugs faced nearly double the risk.

While both of the older and commonly used classes of diabetes medications may help lower blood sugar levels, the drugs also increase the patient’s risk of heart failure and stroke, the researchers concluded.

Sulfonylureas causes the body to release more insulin. It is taken orally and has been used since the 1950s. Basal insulin is injected and designed as a slow release medication.

The newer classes of diabetes drugs also help to reduce blood sugar, but are often more expensive. Yet, these classes of drugs are more effective and pose less risks than the older classes of drugs, according to the findings.

Researchers said the findings of the new study call for a “paradigm shift” for doctors as to how diabetes is treated. Instead of using sulfonylureas or basal insulin drugs as a second line treatment after Metformin, doctors should turn to the other effective classes of drug that carry fewer risks.

The report suggests that if the newer drugs lower the cardiovascular risk, those drugs should be the first line of treatment, not the second. Currently, only about 10-15% of patients are using the newer class of diabetes medications. Many are still using the older classes.

As of now, experts only offer recommendations on which drugs to use as first line treatment. There is no common consensus as to what the second line treatment should be. Researchers indicate the findings of this study should change that.