The Ability of Combination Sulfonylurea and Metformin in Reducing Morbidity and Mortality in Type 2 Diabetes

Abstract

Katie Fletcher, Andrew Meal and Gary G. Adams

Background Literature: Type 2 diabetes is a health concern worldwide, and treatment with oral antidiabetic medicines presents a clinical challenge. This systematic review aims to assess the ability of combination sulfonylurea and metformin in reducing morbidity and mortality in type 2 diabetes.

Methods A search of the databases NU Search, PubMed, Ovid, Embase, CINAHL and Medline was conducted by the author, using key search terms. 11 studies were included, 6 RCT’s, and 5 cohort studies with a combined number of 168,138 participants.

Results Cardiovascular risk: Atherosclerotic Cardiovascular Disease (ASCVD) risk score DPP4i and metformin: -1.5 versus -1.1 for SU and metformin. Six studies found no difference for MI, CVD, stroke across groups for SU, DPP4i, or SGLT2i. DPP4i combination was superior, with better protective effects than SU combined for, Heart failure (HF) HR 0.86 DPP4i versus 1.0 SU, Cerebrovascular disease HR 0.72 versus 1.0 Myocardial Infarction (MI), DPP4i= 340, HR 1.0, versus SU =402, HR 0.84. HbA1c reductions across groups: SU -1.59, DPP4i -2.43 versus -2.91 with SGLT2i. More rapid reduction with SU and metformin versus SGLT2i and DPP4i from 0- week 18. Weight changes across groups: weight gain with SU 5.72kg, versus – 4.27kg for DPP4i and – 20.7kg for SGLT2i.

Conclusion Cardiovascular risk was inconclusive. SU’s were shown to be associated with a rapid reduction of HbA1c and weight gain. More robust research is needed to examine further combination oral antidiabetic treatments and cardiovascular risk, as a high level of heterogeneity (I2 ) and bias between the studies existed.

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