Increase in overall mortality risk in patients with type 2 diabetes receiving glipizide, glyburide or glimepiride monotherapy versus metformin: a retrospective analysis
Diabetes, Obesity and Metabolism, 08/07/2012
Pantalone KM et al. – Glipizide, glyburide and glimepiride are associated with an increased risk of overall mortality versus metformin. The results suggest that if a sulfonylurea is required to obtain glycaemic control, glimepiride may be the preferred sulfonylurea in those with underlying coronary artery disease (CAD).Methods
- A retrospective cohort study was conducted using an academic health centre enterprise-wide electronic health record (EHR) system to identify 23 915 patients with type 2 diabetes who initiated monotherapy with metformin (N = 12774), glipizide (N = 4325), glyburide (N = 4279) or glimepiride (N = 2537), ≥18 years of age, with and without a history of CAD, and not on insulin or a non-insulin injectable at baseline.
- The patients were followed for mortality by documentation in the EHR and Social Security Death Index.
- Multivariable Cox models with propensity analysis were used to compare cohorts.
- An increase in overall mortality risk was observed in the entire cohort with glipizide (HR 1.64; 95% CI 1.39-1.94), glyburide (HR 1.59; 95% CI 1.35-1.88), and glimepiride (HR 1.68; 95% CI 1.37-2.06) versus metformin; however, in those patients with documented CAD, a statistically significant increase in overall mortality risk was only found with glipizide (HR 1.41; 95% CI 1.07-1.87) and glyburide (HR 1.38; 95% CI 1.04-1.83) versus metformin.