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    Mortality risk among sulfonylureas: a systematic review and network meta-analysis

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    graham64
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    Mortality risk among sulfonylureas: a systematic review and network meta-analysis

    Post by graham64 on Sun Nov 09 2014, 21:46

    Background



    Sulfonylureas are common second-line options for management of type 2 diabetes; however, they are associated with a higher risk of cardiovascular events compared with other antidiabetic drugs. Since tissue selectivity and risk of hypoglycaemia differ among sulfonylureas, we aimed to assess whether mortality and the risk of cardiovascular events also varies.

    Methods



    We searched Medline and Embase from inception to June 11, 2014, to identify controlled studies reporting the risk of all-cause mortality, cardiovascular-related mortality, or myocardial infarction for at least two sulfonylureas. We examined differences in cardiovascular event risk among sulfonylureas with random effects models for direct pairwise comparisons and network meta-analyses to incorporate direct and indirect data.

    Findings



    14 970 (9%) of 167 327 patients in 18 studies died: 841 (4%) of 19 334 gliclazide users, 5482 (11%) of 49 389 glimepiride users, 2106 (15%) of 14 464 glipizide users, 5296 (7%) of 77 169 glibenclamide users, 1066 (17%) of 6187 tolbutamide users, and 179 (23%) of 784 chlorpropamide users. Inconsistency was low for the network meta-analysis of all-cause mortality, and the relative risk of death compared with glibenclamide was 0·65 (95% credible interval 0·53—0·79) for gliclazide, 0·83 (0·68—1·00) for glimepiride, 0·98 (0·80—1·19) for glipizide, 1·13 (0·90—1·42) for tolbutamide, and 1·34 (0·98—1·86) for chlorpropamide. Similar associations were noted for cardiovascular-related mortality: the relative risk compared with glibenclamide was 0·60 (95% credible interval 0·45—0·84) for gliclazide, 0·79 (0·57—1·11) for glimepiride, 1·01 (0·72—1·43) for glipizide, 1·11 (0·79—1·55) for tolbutamide, and 1·45 (0·88—2·44) for chlorpropamide.

    Interpretation



    Gliclazide and glimepiride were associated with a lower risk of all-cause and cardiovascular-related mortality compared with glibenclamide. Clinicians should consider possible differences in risk of mortality when selecting a sulfonylurea.

    http://www.thelancet.com/journals/landia/article/PIIS2213-8587(14)70213-X/fulltext

    These drugs have been around for years it makes you wonder about how the clinical trials were conducted Rolling Eyes


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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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    Eddie
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    Re: Mortality risk among sulfonylureas: a systematic review and network meta-analysis

    Post by Eddie on Mon Nov 10 2014, 18:29

    Type two meds, most useless and many dangerous, some banned for killing people FACT. The best reduction in BG numbers quoted by a drug maker is less than two full points HbA1c. But wait for it, only when used with Metformin, ho ho, which can reduce HbA1c by err.....1.5 points.

    Would you like to buy headache pills? they work very well, but only when used with aspirin, oh and btw they cost £100 per month. Don't ya just love big pharma, best salesman and marketing boys in the world.

    This week I am selling paracetamol pills at £10 a piece, Wot! no takers ? I need some tips from big pharma eh. I'm wasted here, I should be on the stage, yeah, I know, sweeping it.

    Already go my coat on.


    _________________
    Type two diabetic-low carb diet (50 carbs per day) and two 500mg Metformin pills per day. Apart from diagnosis HbA1c almost 12-all HbA1c results none diabetic. For over eight years my diabetes medication has not changed. My weight has remained stable, I have suffered no ill effects from my diet whatsoever. Every blood test has proved, I took the right road to my diabetic salvation. For almost seven years, I have asked medical professionals and naysayers, how do I maintain non diabetic BG levels on two Metformin other than low carb ? The silence has been deafening !

      Current date/time is Thu Nov 23 2017, 18:15