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Glucose Lowering Therapy Effects on Cardiovascular Risk

Sep 27, 2013

Oral diabetic medications do not have a significant effect on cardiovascular risk…. 

Czupryniak et al assessed the safety of metformin use in type 2 diabetes (T2D) patients over the age of 80. 158 patients over 80 years old were retrospectively analyzed for 3 years and compared to gender and BMI matched T2D patients between the ages of 60-70. They found that glucose control and the cardiovascular risk profile is more favorable in the metformin group, suggesting metformin may be used effectively and safely in patients over 80 years old.


Garafolo et al reported on the results of pioglitazone vs. glyburide as add on therapy to metformin on the endothelial function of T2DM patients with CV disease. Though T2DM patients on pioglitazone therapy have reduced risk for cardiovascular disease, the 24 week addition of pioglitazone as compared to glyburide to metformin was not associated with a significant change in endothelial function

A retrospective cohort study conducted by Klein et. al., evaluated over 54,000 patients for the risk of heart failure, myocardial infarction, and stroke in patients currently prescribed exenatide twice daily or any insulin. They found that treatment with exenatide was associated with a significantly lower risk of HF, MI, and stroke during 4 years follow-up compared with patients on insulin.

Practice Pearls:
  • Metformin is safe and effective in patients over 80 years old.
  • Pioglitazone does not have a significant change in cardiovascular endothelial function compared to glyburide.
  • Exenatide is associated with a lower risk for HF, myocardial infarction, and stroke compared to insulin.

EASD Barcelona, September 26 2013

  1. L Czupryniak, N Szyłło, E Szymańska-Garbacz, M Pawłowski, M Saryusz-Wolska, and J Loba. Metformin safety in the very elderly.
  2. M Garofolo, L Pucci, D Lucchesi, R Bruno, E Russo, V Sancho Bornez. Effects of pioglitazone vs glyburide on endothelial function in type 2 diabetic patients with vascular complications: the SPLENDOR study.
  3. K Klein, JH Best, SP Marso, D Maggs, and SK Paul. Long-term cardiovascular outcomes with exenatide twice daily compared to insulin: a retrospective observational study.