A study led by academics at The University of Nottingham and published in
The BMJ has compared diabetes drugs in their ability to control blood sugar levels and prevent serious complications.
The research, by Professor Julia Hippisley-Cox and Professor Carol Coupland in the University’s Division of Primary Care, found important differences between diabetes drugs, used alone or in combination, and the potential risks of blindness, amputation, severe kidney failure, high blood sugar (hyperglycaemia) and low blood sugar (hypoglycaemia).
Professor Hippisley-Cox said: “This was an observational study so we cannot draw any firm conclusions about cause and effect. However, these results may have implications for prescribing and we would suggest that doctors and patients should be aware when assessing the overall risks and benefits of diabetes drugs.”
The researchers used a large UK primary care database called QResearch to analyse data collected from 469,688 adult patients with type 2 diabetes between 2007 and 2015. The study focussed particularly on glitazones (also called thiazolidinediones) and gliptins used alone or in combination with other diabetes drugs such as metformin and sulphonylureas. When assessing the information, they also took into account influential factors including age, sex, duration of their diabetes, smoking status and deprivation.
New information on risks
Their results found:
• Treatment with gliptins or glitazones on their own was associated with an increased risk of kidney failure compared with treatment with metformin alone
• Dual treatment for glitazones or gliptins with metformin showed reduced risks of high blood sugar compared with the use of metformin alone
• Triple therapy involving metformin, sulphonylureas and glitazones was associated with a significant decrease in the risk of blindness
• Triple therapy using metformin, sulphonylureas and either glitazones or gliptins was associated with significantly increased risks of low blood sugar but these risks were similar to those involving dual therapy with metformin and sulphonylureas.
Although the numbers of patients who were receiving gliptins or glitazones on their own were relatively low, the results appear to support previous reports of safety of gliptins which are excreted by the kidneys.
The findings for glitazones are also consistent with associated increased risks in chronic kidney disease reported in a previous study of almost 4,000 patients in Taiwan between 2003 and 2009. One such glitazone – pioglitazone – has already been withdrawn from use in France and Germany and is used with caution in Switzerland.
Professor Julia Hippisley-Cox added: “Our research adds new information on the potential risks and benefits of different types of medication used to treat type 2 diabetes which may inform future guidelines. However, we would advise patients to continue taking their prescribed medication as normal and to discuss any concerns that they might have with their GP at their next routine appointment.”
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Notes to editors: The University of Nottingham has 43,000 students and is ‘the nearest Britain has to a truly global university, with a “distinct” approach to internationalisation, which rests on those full-scale campuses in China and Malaysia, as well as a large presence in its home city.’ (Times Good University Guide 2016). It is also one of the most popular universities in the UK among graduate employers and the winner of ‘Outstanding Support for Early Career Researchers’ at the Times Higher Education Awards 2015. It is ranked in the world’s top 75 by the QS World University Rankings 2015/16, and 8th in the UK by research power according to the Research Excellence Framework 2014. It has been voted the world’s greenest campus for three years running, according to Greenmetrics Ranking of World Universities.
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QResearch® is a non-profit making venture run by The University of Nottingham in collaboration with EMIS. More than 600 EMIS practices, representing around eight million patients, regularly contribute to the database. The system anonymises and uploads practices’ clinical data to the central database. Then, to protect patient confidentiality, the data are further anonymised and the figures are totalled to produce data that are suitable for research.
EMIS Group is the UK’s leading supplier of healthcare software and related services to GP practices.