All-Cause and Cardiovascular Mortality following Treatment with Metformin or Glyburide in Patients with Type 2 Diabetes Mellitus

Arch Iran Med. 2017 Mar;20(3):141-146.

Abstract

Background: Both metformin and sulfonylurea (SU) drugs are among the most widely-used anti-hyperglycemic medications in patients with type 2 diabetes mellitus (T2DM). Previous studies have shown that treatment with SUs might be associated with decreased survival compared with metformin. This study aimed to evaluate all-cause and cardiovascular mortality rates between glyburide and metformin in patients diagnosed with T2DM.

Methods: This was a cohort study on 717 patients with T2DM (271 undergoing monotherapy with glyburide and 446 with metformin). Data were gathered from 2001 to 2014. All-cause and cardiovascular mortality were end-points.

Results: During the follow-up, 24 deaths were identified, of which 13 were cardiovascular in nature. The group with glyburide monotherapy had greater all-cause mortality (17 (6.3%) in glyburide vs. 7 (1.6%) in metformin, P = 0.001) and cardiovascular mortality (11 (4.1%) in glyburide vs. 2 (0.4%) in metformin; P = 0.001). Metformin was more protective than glyburide for both all-cause (HR: 0.27 [0.10 - 0.73] P-value = 0.01) and cardiovascular mortality (HR: 0.12 [0.20 - 0.66], P-value = 0.01) after multiple adjustments for cardiovascular risk factors. Among adverse cardiovascular events, non-fatal MI was higher in glyburide compared to metformin monotherapy group (3.2% vs. 0.8%; P-value = 0.03), but not coronary artery bypass grafting (P-value = 0.85), stenting (P-value = 0.69), need for angiography (P-value = 0.24), CCU admission (P-value = 0.34) or cerebrovascular accident (P-value = 0.10).

Conclusion: Treatment with glyburide is associated with increased all-cause and cardiovascular mortality in patients with T2DM.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / mortality*
  • Cause of Death
  • Cohort Studies
  • Coronary Angiography / statistics & numerical data
  • Coronary Artery Bypass / statistics & numerical data
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / epidemiology
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / surgery
  • Coronary Care Units / statistics & numerical data
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Female
  • Glyburide / therapeutic use*
  • Humans
  • Hypoglycemic Agents / therapeutic use*
  • Iran / epidemiology
  • Male
  • Metformin / therapeutic use*
  • Middle Aged
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / mortality
  • Protective Factors
  • Retrospective Studies
  • Risk Factors
  • Stroke / epidemiology
  • Stroke / mortality

Substances

  • Hypoglycemic Agents
  • Metformin
  • Glyburide