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Whittington Health NHSUCL

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Gliclazide (sulphonylureas) and heart failure

There have been some articles in the press recently about Gliclazide (sulphonylureas), which is a drug used by some people to help control diabetes, and the increased risk of heart failure.

What did this study find?

  • Researchers compared the risk of heart failure and heart attacks in people with type 2 diabetes whose first and only medication was either a sulphonylurea (like gliclazide) or metformin.
  • They found a small increase in the risk in people started on sulphonylureas (like gliclazide).
  • The increased risk was relatively small with 4 incidents of heart failure  in every 1000 people started on sulphonylureas.

What does this study mean for me?

  • These results do not apply to people taking both metformin and sulphonylurea together.
  • The results of this study only apply to a small number of people. UK guidelines advise that people should be started on metformin first unless there is a good reason not too (like very low kidney function or problems with side-effects).
  • Increasing weight may be the reason why sulphonylureas increase the risk of heart problems, so it may be possible to counteract this by eating healthily and being physically active.
  • No-one should stop taking sulphonylureas based on these results.

How did they do this study?

The researchers looked at the medical records of 139,172 people in America with type 2 diabetes who had been started on either metformin or a sulphonylurea (like gliclazide). They matched people so they had similar risks of having heart failure or heart disease. 

The researchers then looked at the number of people who had to be admitted to hospital with heart failure or died from heart problems in a 10 year period from 2001-2011.

They found that in 1 year, for every 1000 people taking a sulphonylurea there were 12.4 such events, compared to 8.9 events in people taking metformin. That’s an extra 3.5 events, meaning that in every 1000 people who were given a sulphonylurea as their first and only medication for diabetes, 3.5 more had a hospital admission or died than in every 1000 people given metformin as their first and only medication for diabetes.  

The study has a number of limitations. Only 3% of participants were women and 97% were men so we don’t know whether this result is relevant for women. It is also a retrospective study that looked back on old data so the results are lower quality and at a higher risk of bias than a randomized trial. 

You can find the original article in the Journal of the American Heart Association.

Gliclazide (sulphonylureas) and heart failure

 

There have been some articles in the press recently about Gliclazide (sulphonylureas), which is a drug used by some people to help control diabetes, and the increased risk of heart failure.

 

What did this study find?

·         Researchers compared the risk of heart failure and heart attacks in people with type 2 diabetes whose first and only medication was either a sulphonylurea (like gliclazide) or metformin.

·         They found a small increase in the risk in people started on sulphonylureas (like gliclazide).

·         The increased risk was relatively small with 4 incidents of heart failure  in every 1000 people started on sulphonylureas.

 

What does this study mean for me?

·         These results do not apply to people taking both metformin and sulphonylurea together.

·         The results of this study only apply to a small number of people. UK guidelines advise that people should be started on metformin first unless there is a good reason not too (like very low kidney function or problems with side-effects).

·         Increasing weight may be the reason why sulphonylureas increase the risk of heart problems, so it may be possible to counteract this by eating healthily and being physically active.

·         No-one should stop taking sulphonylureas based on these results.

How did they do this study?

The researchers looked at the medical records of 139,172 people in America with type 2 diabetes who had been started on either metformin or a sulphonylurea (like gliclazide). They matched people so they had similar risks of having heart failure or heart disease.

The researchers then looked at the number of people who had to be admitted to hospital with heart failure or died from heart problems in a 10 year period from 2001-2011.

They found that in 1 year, for every 1000 people taking a sulphonylurea there were 12.4 such events, compared to 8.9 events in people taking metformin. That’s an extra 3.5 events, meaning that in every 1000 people who were given a sulphonylurea as their first and only medication for diabetes, 3.5 more had a hospital admission or died than in every 1000 people given metformin as their first and only medication for diabetes. 

The study has a number of limitations. Only 3% of participants were women and 97% were men so we don’t know whether this result is relevant for women. It is also a retrospective study that looked back on old data so the results are lower quality and at a higher risk of bias than a randomized trial.

 

You can find the original article in the Journal of the American Heart Association.

Sugar tax and diabetes

People living with type 2 diabetes are often told to eat less sugar. But this is something that actually applies to the whole population – on average most people are eating too much sugar.

To encourage the food industry to reduce the amount of sugar that gets added to our food, the government is trying 2 things. A sugary drinks industry levy (‘sugar tax’) on soft drinks and a programme to reduce the amount of sugar in food by 20 per cent.

Overall this should have health benefits for everyone.

However there is a problem with the sugar tax. To avoid the tax (which starts in April 2018), many companies have started to change the composition of their drinks. Sugar is being removed and often replaced by artificial sweeteners. This could be a problem for people who suffer from hypos (low blood glucose levels) because of medicines like gliclazide or insulin.

Previously, one of the treatment options for a hypo was 100mls of Lucozade. From April 2017 the amount of sugar in Lucozade has been halved and people will need 200mls of the new Lucozade to get the 15-20g of sugar needed to treat a hypo.

Shops will have both new and old stock of Lucozade on their shelves for some time so anyone who uses soft drinks to treat hypos needs to look at the label very carefully.

To get advice on other ways of managing a hypo, read our page on hypo-treatment.

You can read more about this by clicking on the links below:

Diabetes.co.uk

Statins are safe and save lives

A group of expert medical researchers across the world has looked at the best available evidence on the effects of people taking statins to lower cholesterol.
They calculated the effects on 10,000 people taking statins to lower their cholesterol by 2mmol/L for 5 years.

What did this study find?

  • This would prevent 1000 heart attacks or strokes every year in people at high risk – like people who have been living with diabetes for some time or people who have already had a heart attack or stroke.
  • It would prevent 500 heart attacks or strokes every year in people at lower-risk – like younger people with diabetes or people with high blood pressure.
  • It would reduce the risk of dying from a heart attack by 40 percent.
  • Statins did NOT cause aches and pains, memory problems or serious liver damage.
  • For every 10,000 people treated with statins, there might be 5 cases of muscle damage, 50-100 new diagnoses of diabetes and 5-10 cases of bleeding in the brain.

What does this study mean for me?

  • Statins are very effective at preventing heart attacks or strokes.
  • This is even more important in people living with type 2 diabetes as most people would fall into a higher-risk category.
  • Side effects from statins are very rare and affect less than 1 in 1000 people.
  • Scare stories in the UK media have stopped many people from taking statins and this has caused up to 6000 heart attacks or strokes that could have been avoided.
  • If you do get muscle pains after taking a statin, a simple blood test done by your doctor can tell you if it is related to the statin or a coincidence.

How did they do this study?

This report was published in the Lancet and 28 world-leading researchers from Oxford, Cambridge, Bristol, London, America, Canada and Australia looked at the evidence from studies on statins. They found good evidence for significant benefits from taking statins. Most of the reports of side effects were from low quality studies and were not backed up by high quality evidence.

High quality studies are randomized controlled trials that compare the effect of a medicine in one group with the effect of a dummy pill (placebo) on the other group. This makes the results more reliable so that any benefits or side effects can be correctly linked to the medicine being tested.
These high quality studies showed large and significant reductions in the risks of serious problems with blood vessels like heart attacks or strokes. Every 1mmol/L reduction in LDL-cholesterol reduces the risk of these problems by 25% every year that a statin is taken.

Reports of side effects like aches and pains, memory problems or other odd side effects were only found in low quality studies and were probably due to other problems or medication, not statins.

There are two potentially serious side effects from taking statins but these are rare and affect less than 1 in 1000 people. Statins cause the breakdown of muscles in some people but this can easily be detected by a blood test for muscle enzymes (creatine kinase). A very small number of people might be affected by a bleed in the brain – but statins are still worth it because they prevent the more common type of stroke caused by blood clots in the brain.
In 10,000 people starting on statins 50-100 extra people will be diagnosed with diabetes. This seems to happen in people who are at risk of diabetes and may have developed the condition anyway. Even for these people, the benefits of statins hugely outweigh the risks as they are so effective at preventing heart attacks and strokes.

Overall, we can confidently say that statins are one of the most effective treatments available and they save thousands of lives every year. There are potentially serious side effects, but these are rare. If you have concerns – discuss things with your doctor and make decisions based on good quality evidence rather than scare stories in the media.

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