Some glucose-lowering medications may increase the risk of heart failure in patients with or at risk for type 2 diabetes, with variations seen among different drug classes. The results of this study were presented at the American College of Cardiology’s 64th Annual Scientific Session and published in The Lancet Diabetes and Endocrinology.

Data was reviewed from 14 randomized controlled trials of 95,502 patients with or at risk for type 2 diabetes taking new or more intensive glucose-lowering medications or strategies and cardiovascular outcomes; the primary endpoint was incidence of heart failure. Across all trials, 4% of patients developed a heart failure event and almost 10% suffered a major adverse cardiovascular event. Overall, glucose-lowering medications or strategies increased the risk for heart failure by around 14% compared to standard of care or placebo.

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The heart failure risk was greatest in patients taking peroxisome proliferator-activated receptor agonists (PPARs), intermediate with dipeptidyl peptidase-4 (DPP-4) inhibitors, and neutral with insulin glargine. Target-based intensive glycemic control strategies and intensive weight loss were not associated with an increased risk. For every 1kg of weight gain attributed to a glucose-lowering medication or strategy, there was a 7% increased risk of heart failure directly associated with that drug or strategy.

Proactive steps to reduce the risk for development of heart disease can be beneficial to this population, the authors conclude.

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