Study Details the Benefits and Risks of New Diabetes Agents

A recent meta-analysis assessed the risks and benefits associated with newer diabetes drugs, including gliptins or glitazones.

Specifically, researchers examined the risk of amputation, blindness, severe kidney failure, hyperglycemia, and hypoglycemia in patients with type 2 diabetes who were prescribed these drugs.
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Previous research into the risks and benefits of the newer diabetes drugs has relied on “surrogate endpoints such as reduction of HbA1c rather than hard clinical endpoints such as increased survival rates or reduced incidence of complications,” according to researchers.

The meta-analysis involved 469,688 participants aged 25-84 from 1243 practices in England.

Overall, 21,308 patients were given glitazones and 32,533 were given gliptins during follow-up.

Patients taking glitazones had decreased risk of blindness but an increased risk of hypoglycemia compared to non-use. Those taking gliptins were less likely to have hypoglycemia.

Patients prescribed either gliptin monotherapy or glitazones monotherapy had significantly higher risk of severe kidney failure than those taking metformin monotherapy. Those taking dual therapy consisting of metformin and either of the newer drugs had significantly lower risk of hyperglycemia compared with metformin monotherapy.

Triple therapy with metformin, sulphonylureas, and either of the newer agents was associated with significantly higher risk of hypoglycemia than those taking metformin alone, although these risks were similar to those seen in patients taking dual therapy with metformin and sulphonylureas.

“These results, while subject to residual confounding, could have implications for the prescribing of hypoglycaemic drugs,” they concluded.

—Michael Potts

Reference:
Hippisley-Cox J, Coupland C. Diabetes treatments and risk of amputation, blindness, severe kidney failure, hyperglycaemia, and hypoglycaemia: open cohort study in primary care. BMJ. 2016;352:i1450.