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


Authors: Floyd, J. S.; Wiggins, K. L.; Sitlani, C. M.; Flory, J. H.; Dublin, S.; Smith, N. L.; Heckbert, S. R.; Psaty, B. M.
Article Title: Case-control study of second-line therapies for type 2 diabetes in combination with metformin and the comparative risks of myocardial infarction and stroke
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. © 2015 John Wiley & Sons Ltd.
Keywords: adult; controlled study; major clinical study; drug safety; letter; medical record review; cardiovascular risk; heart infarction; stroke; insulin; observational study; metformin; sulfonylurea derivative; non insulin dependent diabetes mellitus; myocardial infarction; cerebrovascular accident; population based case control study; case-control study; human; male; female; cardiovascular outcomes; comparative safety; sulphonylureas
Journal Title: Diabetes, Obesity and Metabolism
Volume: 17
Issue: 12
ISSN: 1462-8902
Publisher: John Wiley & Sons  
Date Published: 2015-12-01
Start Page: 1194
End Page: 1197
Language: English
DOI: 10.1111/dom.12537
PROVIDER: scopus
PMCID: PMC4626290
PUBMED: 26179389
DOI/URL:
Notes: Export Date: 2 December 2015 -- Source: Scopus
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  1. James H Flory
    36 Flory