Linagliptin vs glimepiride for cardiovascular risk in early T2D

Takeaway

• Linagliptin is noninferior to glimepiride for cardiovascular safety in adults with relatively early type 2 diabetes (T2D) and elevated cardiovascular risk.

Why this matters

• “When choosing medications to manage type 2 diabetes, cardiovascular safety, glucose-lowering potency, hypoglycaemia risk, effect on body weight, and cost are important considerations,” say researchers.

Study design

• CAROLINA noninferiority trial of 6033 patients (mean age, 64.0 years; 39.9% women) with T2D (mean HbA1c, 7.2% [range, 6.5%-8.5%]) and elevated cardiovascular risk.
• Participants were randomly assigned to receive 5 mg of linagliptin or 1-4 mg of glimepiride once daily in addition to usual care.
• Funding: Boehringer Ingelheim; Eli Lilly and Company.

Key results

• Primary endpoint was time to first occurrence of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke over a median follow-up of 6.3 years.
• The primary outcome occurred in 11.8% (356/3023) of linagliptin-treated patients vs 12.0% (362/3010) receiving glimepiride.
  • HR was 0.98 and met the criteria for noninferiority (P<.001) but not superiority (P=.76).
• Proportion of patients with ≥1 hypoglycaemic adverse event was lower with linagliptin vs glimepiride (10.6% vs 37.7%), corresponding to a 77% risk reduction (HR=0.23; 95% CI, 0.21-0.26).

Limitations

• Results may not apply to patients with more advanced diabetes.