Glimepiride: cardiovascular and hypoglycaemic safety

  • Douros A & al.
  • Diabetes Obes Metab
  • 9 Oct 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with type 2 diabetes (T2D), glimepiride was associated with a lower incidence of all-cause mortality compared with other second-generation sulfonylureas while there was a non-significant trend towards a higher incidence of severe hypoglyceamia.
  • No significant difference was observed in the incidence of myocardial infarction (MI) and ischaemic stroke between glimepiride and other second-generation sulfonylureas.

Why this matters

  • Findings may help in interpreting the upcoming results of the GRADE and CAROLINA trials that used glimepiride as an active comparator with respect to other commonly used sulfonylureas.

Study design

  • This study included 66,032 patients with T2D who initiated a sulfonylurea between 1998 and June 2016 using the Clinical Practice Research Datalink (CPRD).
  • Glimepiride initiators were matched (1:4) with other second-generation sulfonylureas initiators.
  • Main outcomes: myocardial infarction, ischaemic stroke, severe hypoglycaemia, cardiovascular death, and all-cause mortality.
  • Funding: The Canadian Institutes of Health Research and others.

Key results

  • Glimepiride vs other second-generation sulfonylureas was associated with a similar incidence of MI (HR, 0.99; 95% CI, 0.75-1.30) and ischaemic stroke (HR, 0.96; 95% CI, 0.72-1.27) whereas there was a non-significant trend towards a higher incidence of severe hypoglycemia (HR, 1.24; 95% CI, 0.92-1.68).
  • Glimepiride was associated with a reduction in the incidence of all-cause mortality (HR, 0.77; 95% CI, 0.67-0.89) and a non-significant but similar trend for cardiovascular death (HR, 0.83; 95% CI, 0.65-1.05).

Limitations

  • Risk of residual confounding.
  • Short follow-up period.