(HealthDay News) – Use of sulfonylureas for initial treatment of diabetes is associated with increased cardiovascular events and death compared with metformin, according to a study published in the Nov 6 issue of the Annals of Internal Medicine.

Christianne L Roumie, MD, MPH, from the Veterans Affairs Tennessee Valley Healthcare System in Nashville, and colleagues conducted a retrospective cohort study to compare outcomes for 253,690 veterans who initiated metformin (155,025) or sulfonylurea (98,665) therapy for diabetes. The composite outcome consisted of hospitalization for acute myocardial infarction or stroke, or death, adjusting for baseline demographic and medical characteristics.

The researchers found that crude rates for the composite outcome were 18.2 per 1,000 person-years in sulfonylurea users and 10.4 per 1,000 person-years in metformin users (adjusted incidence rate difference, 2.2 more cardiovascular events with sulfonylureas per 1,000 person-years; adjusted hazard ratio [aHR], 1.21). For both glyburide (aHR, 1.26) and glipizide (aHR, 1.15) results were consistent in subgroup analyses and in propensity score-matched cohort and sensitivity analyses.

“These observations support the use of metformin for first-line diabetes therapy and strengthen the evidence about the cardiovascular advantages of metformin compared with sulfonylureas,” the authors write.

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