The generic metformin (Mallinkrodt) significantly reduced the risk of dying from heart attack and stroke compared to other common diabetes medications, according to a new study.
Researchers at The Johns Hopkins University School of Medicine and other US universities conducted an extensive analysis comparing the effectiveness and safety of monotherapy (thiazolidinediones, metformin, sulfonylureas, dipeptidyl peptidase-4 [DPP-4] inhibitors, sodium–glucose cotransporter 2 [SGLT-2] inhibitors, and glucagon-like peptide-1 [GLP-1] receptor agonists) with selected metformin-based combinations in adults with type 2 diabetes.
In the article, published online in the April 19, 2016, issue of the Annals of Internal Medicine, the researchers analyzed 179 trials and 25 observational studies of head-to-head monotherapy or metformin-based combinations.
They found that cardiovascular mortality was lower for metformin versus sulfonylureas.
“The evidence supports metformin as first-line therapy for type 2 diabetes, given its relative safety and beneficial effects on hemoglobin A1c, weight, and cardiovascular mortality (compared with sulfonylureas),” the researchers wrote. “On the basis of less evidence, results for add-on therapies to metformin were similar to those for monotherapies.”
In addition, patients’ body weight was reduced or maintained with metformin, DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT-2 inhibitors and increased with sulfonylureas, thiazolidinediones, and insulin.
While hypoglycemia was more frequent with sulfonylureas, gastrointestinal adverse events were highest with metformin and GLP-1 receptor agonists.
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