Study: Certain Diabetes Drugs Tied to Mortality
Jeff Minerd of MedPageToday writes about a study from the Jan. 17 issue of the Canadian Medical Association Journal that examined diabetic drugs Daibinese (chlorpropamine) and Orinase (tulbutomide).
Patients were placed into three groups. There were 120 who received a first-generation sulfonylurea, either Daibinese (chlorpropamine) or Orinase. A second group included 4,138 who received Diabeta (glyburide), and the third group included 1,537 who received the non-sulfonylurea drug metformin, which improves insulin sensitivity.
Each of these groups was further divided into a high-dose or low-dose group, with the median daily dose serving as the dividing line.
Participants were followed until death or termination of Saskatchewan Health coverage. Average follow up was about five years. The main outcomes were all-cause mortality and death from an acute ischemic event.
There were 1,503 deaths during the study period, of which 372 (about 25%) were attributable to an acute ischemic event. First-generation sulfonylurea users had the highest mortality (67.6 deaths per 1,000 person-years), compared with Diabeta users (61.4 deaths per 1,000 person-years) and metformin users (39.6 deaths per 1,000 person-years).
Compared with the low-dose patients, a greater risk of death was found in the high-dose patients receiving first-generation sulfonylureas (adjusted hazard ratio=2.1; 95% confidence interval=1.0-4.7) and Diabeta (HR=1.3; 95% CI= 1.2-1.4), but not metformin (HR=0.8; 95% CI=0.7-1.1).
The study also found an increased risk of death from ischemic event in the high-dose patients receiving first-generation sulfonylureas, though it was not statistically significant (HR=1.21; 95% CI=0.10-3.75). A significant association was found for Diabeta (HR=1.37; 95% CI=1.25-1.50). A slight and non-significant association was found for metformin (HR=1.10; 95% CI=0.75-1.30).