Comparable Long-Term Mortality Risk Associated With Individual Sulfonylureas in Diabetes Patients With Heart Failure

Diabetes Res Clin Pract. 2011 Oct;94(1):119-25. doi: 10.1016/j.diabres.2011.07.011. Epub 2011 Aug 9.

Abstract

Aims: The aim was to investigate the outcomes of individual sulfonylureas in patients with heart failure (HF).

Methods: All patients hospitalized with HF for the first time in 1997-2006, alive 30 days after discharge, and who received anti-diabetic monotherapy with glimepiride (n=1097), glibenclamide (glyburide) (n=1031), glipizide (n=557), gliclazide (n=251), or tolbutamide (n=541) were identified from nationwide registers. Risk of all-cause mortality was assessed by multivariable Cox regression models.

Results: Over the median observational time of 744 (Inter Quartile Range 268-1451) days, 2242 patients (64%) died. The analysis demonstrated similar hazard ratio (HR) for mortality for treatment with glimepiride (1.10 [95% confidence interval 0.92-1.33]), glibenclamide (1.12 [0.93-1.34]), glipizide (1.14 [0.93-1.38]), tolbutamide (1.04 [0.85-1.26]), and gliclazide (reference). Grouped according to pancreatic specificity, i.e., with tolbutamide, glipizide, and gliclazide as specific, and glibenclamide, and glimepiride as non-specific agents, no differential prognosis was found between the two groups (HR 1.04 [0.96-1.14], for non-specific, compared to pancreas specific agents). The prognosis was not dependent on prior acute myocardial infarction or ischemic heart disease (p for interactions >0.3).

Conclusions: In current clinical practice, it is unlikely that there are considerable differences in risk of mortality associated with individual sulfonylureas in patients with heart failure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Diabetes Mellitus / drug therapy*
  • Female
  • Glipizide / adverse effects
  • Glipizide / therapeutic use
  • Glyburide / adverse effects
  • Glyburide / therapeutic use
  • Heart Failure / chemically induced*
  • Heart Failure / mortality*
  • Humans
  • Hypoglycemic Agents / adverse effects*
  • Hypoglycemic Agents / therapeutic use*
  • Male
  • Sulfonylurea Compounds / adverse effects*
  • Sulfonylurea Compounds / therapeutic use*
  • Tolbutamide / adverse effects
  • Tolbutamide / therapeutic use

Substances

  • Hypoglycemic Agents
  • Sulfonylurea Compounds
  • glimepiride
  • Tolbutamide
  • Glyburide
  • Glipizide