Some types of glucose-lowering medications used by adults with type 2 diabetes are better than others when it comes to reducing the risk of heart attack and stroke, a new Kaiser Permanente study found.
“People with type 2 diabetes are at high risk of experiencing or dying from a heart attack, stroke, and other forms of cardiovascular disease,” said Romain Neugebauer, PhD, a research scientist at the Kaiser Permanente Division of Research who led the study. “It is important that physicians and patients are aware of which medications not only can work well at controlling diabetes but can also improve heart health.”
The study, published in JAMA Network Open, analyzed data collected on close to 300,000 adults with type 2 diabetes who had recently been prescribed one of 4 types of diabetes medications: GLP-1 receptor agonists, SGLT2 inhibitors, sulfonylureas, and DPP4 inhibitors. Most patients had previously been on another diabetes medication, typically metformin.
The study included patients from Kaiser Permanente in Northern California, Southern California, and Hawaii as well as patients seen at Geisinger in Pennsylvania; Henry Ford Health System in Michigan; and HealthPartners in Minnesota and Wisconsin.
The researchers found that:
- GLP-1 receptor agonists — such as liraglutide and semaglutide — offered the most protection against heart attacks and strokes.
- SGLT2 inhibitors — such as empagliflozin — were the second most effective.
- Sulfonylureas medications — such as glipizide or glimepiride — were the third most effective.
- DPP4 inhibitors — such as sitagliptin and linagliptin — were the least effective.
The study also showed that some patients benefitted more from the GLP-1 receptor agonists than from the SGLT2 inhibitors. These were patients who:
- already had atherosclerotic cardiovascular disease or heart failure
- were 65 or older
- or had moderate kidney problems.
In adults under age 50, both types of drugs were about equally effective in decreasing cardiovascular risks.
“There are millions of Americans with type 2 diabetes and many different medications they can be prescribed to treat it,” said senior author Patrick O’Connor, MD, an investigator at HealthPartners Institute. “Because of the size of our study, we were able to provide information to inform medication choices for adults with type 2 diabetes who may already have heart disease as well as for those for whom the goal is to prevent heart problems from developing.”
The researchers said the study’s findings will also help the millions of people with diabetes in other countries. “Medications like GLP-1 receptor agonists and SGLP-2 inhibitors are less available in lower- and middle-income countries than in they are in the U.S.,” said O’Connor. “In these countries, the finding that, on average, and when used continuously, sulfonylureas medications appeared to be more effective than DDP4 inhibitors is also useful information.”
