Metformin vs. Glipizide for Patients with Diabetes and Coronary Disease
Metformin was associated with better cardiovascular outcomes.
Observational data have suggested that metformin, compared with sulfonylureas, protects patients with type 2 diabetes against adverse cardiovascular events. In this double-blind trial from China, researchers randomly assigned 304 diabetic patients with documented coronary artery disease to receive either metformin or glipizide for 3 years. At baseline, mean glycosylated hemoglobin (HbA1c) was 7.6%; most patients were taking aspirin and statins. During the study, insulin was added in about 25% of patients in each group. After the formal 3-year randomized intervention, monitoring of patients continued, with average total follow-up of 5 years.
The primary outcome was a broad composite of nonfatal cardiovascular events and death from any cause. Sixty events occurred in 41 glipizide recipients (35%), and 43 events occurred in 39 metformin recipients (25%). In a time-to-event analysis, the primary outcome was less likely with metformin than with glipizide (hazard ratio, 0.54; P=0.026). Fourteen patients in the glipizide group and 7 in the metformin group died. Glycemic control and lipid levels were similar in the two groups. On average, glipizide recipients gained 1 kg, and metformin recipients lost 1 kg. The incidence of hypoglycemia was similar in the two groups.
CITATION(S):
Hong J et al. Effects of metformin versus glipizide on cardiovascular outcomes in patients with type 2 diabetes and coronary artery disease. Diabetes Care 2013 May; 36:1304.