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.
© 2015 John Wiley & Sons Ltd.
Publication types
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Comparative Study
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Research Support, N.I.H., Extramural
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Research Support, Non-U.S. Gov't
MeSH terms
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Aged
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Case-Control Studies
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Diabetes Mellitus, Type 2 / complications
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Diabetes Mellitus, Type 2 / drug therapy*
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Diabetic Angiopathies / chemically induced
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Diabetic Angiopathies / complications
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Diabetic Angiopathies / epidemiology
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Diabetic Angiopathies / prevention & control
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Diabetic Cardiomyopathies / chemically induced
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Diabetic Cardiomyopathies / complications
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Diabetic Cardiomyopathies / epidemiology
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Diabetic Cardiomyopathies / prevention & control
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Drug Therapy, Combination / adverse effects
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Female
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Humans
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Hypoglycemic Agents / adverse effects
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Hypoglycemic Agents / therapeutic use*
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Incidence
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Insulin / adverse effects
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Insulin / therapeutic use*
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Male
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Medical Records
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Metformin / adverse effects
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Metformin / therapeutic use*
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Middle Aged
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Myocardial Infarction / chemically induced
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Myocardial Infarction / complications
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Myocardial Infarction / epidemiology
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Myocardial Infarction / prevention & control*
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Practice Guidelines as Topic
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Proportional Hazards Models
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Risk Factors
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Stroke / chemically induced
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Stroke / complications
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Stroke / epidemiology
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Stroke / prevention & control*
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Sulfonylurea Compounds / adverse effects
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Sulfonylurea Compounds / therapeutic use*
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Washington / epidemiology
Substances
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Hypoglycemic Agents
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Insulin
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Sulfonylurea Compounds
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Metformin