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    Comparative Safety of Sulfonylurea and Metformin Monotherapy on the Risk of Heart Failure

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    graham64
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    Comparative Safety of Sulfonylurea and Metformin Monotherapy on the Risk of Heart Failure

    Post by graham64 on Wed May 31 2017, 22:00

    Abstract

    Background Medications that impact insulin sensitivity or cause weight gain may increase heart failure risk. Our aim was to compare heart failure and cardiovascular death outcomes among patients initiating sulfonylureas for diabetes mellitus treatment versus metformin.

    Methods and Results National Veterans Health Administration databases were linked to Medicare, Medicaid, and National Death Index data. Veterans aged ≥18 years who initiated metformin or sulfonylureas between 2001 and 2011 and whose creatinine was <1.4 (females) or 1.5 mg/dL (males) were included. Each metformin patient was propensity score‐matched to a sulfonylurea initiator. The outcome was hospitalization for acute decompensated heart failure as the primary reason for admission or a cardiovascular death. There were 126 867 and 79 192 new users of metformin and sulfonylurea, respectively. Propensity score matching yielded 65 986 per group. Median age was 66 years, and 97% of patients were male; hemoglobin A1c 6.9% (6.3, 7.7); body mass index 30.7 kg/m2 (27.4, 34.6); and 6% had heart failure history. There were 1236 events (1184 heart failure hospitalizations and 52 cardiovascular deaths) among sulfonylurea initiators and 1078 events (1043 heart failure hospitalizations and 35 cardiovascular deaths) among metformin initiators. There were 12.4 versus 8.9 events per 1000 person‐years of use (adjusted hazard ratio 1.32, 95%CI 1.21, 1.43). The rate difference was 4 heart failure hospitalizations or cardiovascular deaths per 1000 users of sulfonylureas versus metformin annually.

    Conclusions Predominantly male patients initiating treatment for diabetes mellitus with sulfonylurea had a higher risk of heart failure and cardiovascular death compared to similar patients initiating metformin.

    Full text: http://jaha.ahajournals.org/content/6/4/e005379.full


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    chris c
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    Re: Comparative Safety of Sulfonylurea and Metformin Monotherapy on the Risk of Heart Failure

    Post by chris c on Thu Jun 01 2017, 21:35

    Just add a statin for a double whammy
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    graham64
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    Re: Comparative Safety of Sulfonylurea and Metformin Monotherapy on the Risk of Heart Failure

    Post by graham64 on Thu Jun 01 2017, 22:34

    @chris c wrote:Just add a statin for a double whammy

    Or how about adding PCSK9's for a triple whammy  Laughing


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    Proving the LowCarb sceptics wrong for over nine years,

    Not all cherubs are Angels  Wink nor all diabetics Bonkers  Rolling Eyes
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    graham64
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    Re: Comparative Safety of Sulfonylurea and Metformin Monotherapy on the Risk of Heart Failure

    Post by graham64 on Thu Jun 01 2017, 22:39

    Metformin as a mono therapy has advantages for men

     Effect of Long-term Metformin and Lifestyle in the Diabetes Prevention Program and its Outcome Study on Coronary Artery Calcium

    http://circ.ahajournals.org/content/early/2017/05/05/CIRCULATIONAHA.116.025483


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    I'm a skinny T2 diagnosed 4/4/2008, a high calorie LCHF diet and one metformin a day A1c 6.2 and no complications.

    Proving the LowCarb sceptics wrong for over nine years,

    Not all cherubs are Angels  Wink nor all diabetics Bonkers  Rolling Eyes
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    chris c
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    Re: Comparative Safety of Sulfonylurea and Metformin Monotherapy on the Risk of Heart Failure

    Post by chris c on Thu Jun 01 2017, 22:48

    @graham64 wrote:
    @chris c wrote:Just add a statin for a double whammy

    Or how about adding PCSK9's for a triple whammy  Laughing

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    Re: Comparative Safety of Sulfonylurea and Metformin Monotherapy on the Risk of Heart Failure

    Post by chris c on Thu Jun 01 2017, 22:52

    @graham64 wrote:Metformin as a mono therapy has advantages for men

     Effect of Long-term Metformin and Lifestyle in the Diabetes Prevention Program and its Outcome Study on Coronary Artery Calcium

    http://circ.ahajournals.org/content/early/2017/05/05/CIRCULATIONAHA.116.025483

    Met is one of the only drugs I'd consider taking, not that I'll ever be offered it. It seems to have a bunch of benefits and only one side effect.

    This ties in with a bunch of stuff I've been reading on the effects of hyperinsulinemia - met is one of the few drugs that acts on IR and helps reduce insulin levels. Both glucose and insulin have non-benevolent effects on arteries.
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    graham64
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    Re: Comparative Safety of Sulfonylurea and Metformin Monotherapy on the Risk of Heart Failure

    Post by graham64 on Thu Jun 01 2017, 23:06

    Yes though metformin doesn't come without side effects it's the one drug that does have benefits for us diabetics. 

    I do ask for and get B12 included in blood tests occasionally something  that any long term metformin users should consider


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    I'm a skinny T2 diagnosed 4/4/2008, a high calorie LCHF diet and one metformin a day A1c 6.2 and no complications.

    Proving the LowCarb sceptics wrong for over nine years,

    Not all cherubs are Angels  Wink nor all diabetics Bonkers  Rolling Eyes
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    Jan1
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    Re: Comparative Safety of Sulfonylurea and Metformin Monotherapy on the Risk of Heart Failure

    Post by Jan1 on Fri Jun 02 2017, 13:45

    Reading this reminded me of the post(s) you did with Kath Graham - may well be on the Forum, but is also here:

    Metformin beyond it's blood sugar lowering properties

    http://thelowcarbdiabetic.blogspot.co.uk/2014/01/metformin-beyond-its-blood-sugar.html

    All the best Jan

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