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Comparative Study
. 2015 Dec;17(12):1194-7.
doi: 10.1111/dom.12537. Epub 2015 Oct 5.

Case-control study of second-line therapies for type 2 diabetes in combination with metformin and the comparative risks of myocardial infarction and stroke

J S Floyd  1   2 , K L Wiggins  1 , C M Sitlani  1   2 , J H Flory  3   4 , S Dublin  5   6 , N L Smith  1   5   6   7 , S R Heckbert  1   5   6 , B M Psaty  1   2   5   6
Affiliations
Comparative Study

Case-control study of second-line therapies for type 2 diabetes in combination with metformin and the comparative risks of myocardial infarction and stroke

J S Floyd et al. Diabetes Obes Metab. 2015 Dec.

Abstract

We conducted a population-based case-control study to assess the myocardial infarction (MI) and stroke risks associated with sulphonylureas and insulin when used in combination with metformin. Cases had type 2 diabetes and used metformin + insulin or metformin + sulphonylureas at the time of a first MI or first stroke between 1995 and 2010; controls used the same treatment combinations and were randomly sampled from the same population. MI and stroke diagnoses and potential confounders were validated by medical record reviews. Compared with metformin + sulphonylurea, metformin + insulin was associated with similar risks of MI or stroke [odds ratio 0.98 (95% confidence interval 0.63-1.52)]. Meta-analysis with another observational study improved the precision of the risk estimate [relative risk 0.92 (95% confidence interval 0.69-1.24)]. Current evidence suggests that there may not be large differences in cardiovascular risk associated with the use of insulin or sulphonylureas when used in combination with metformin.

Keywords: cardiovascular outcomes; case-control study; comparative safety; insulin; metformin; myocardial infarction; stroke; sulphonylureas.

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Conflict of interest statement

CONFLICTS OF INTEREST

Psaty serves on the DSMB of a clinical trial of a device funded by the manufacturer (Zoll LifeCor) and on the Steering Committee of the Yale Open Data Access Project funded by Johnson & Johnson.

References

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