Comparative cardiovascular and hypoglycaemic safety of glimepiride in type 2 diabetes: A population‐based cohort study

• Published in: Diabetes, obesity & metabolism Vol. 22; no. 2; pp. 254 - 262
• Main Authors: Douros, Antonios, Dell'Aniello, Sophie, Yu, Oriana Hoi Yun, Suissa, Samy
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.02.2020; Wiley Subscription Services, Inc
• Subjects: Aged; cardiovascular disease; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; CAROLINA; Cerebral infarction; Cohort analysis; Cohort Studies; Databases, Factual; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - mortality; Epidemiology; Female; Health risk assessment; Heart attacks; Hospitalization - statistics & numerical data; Humans; Hypoglycemia; Hypoglycemia - chemically induced; Hypoglycemia - epidemiology; Incidence; Male; Middle Aged; Mortality; Myocardial infarction; pharmaco‐epidemiology; Population studies; Population-based studies; Sulfonylurea Compounds - adverse effects; Sulfonylurea Compounds - therapeutic use; type 2 diabetes; United Kingdom - epidemiology; United Kingdom; cardiovascular disease; pharmaco-epidemiology; type 2 diabetes; CAROLINA
• ISSN: 1462-8902; 1463-1326
• DOI: 10.1111/dom.13893

Aim To assess the incidence of cardiovascular and hypoglycaemic adverse events associated with glimepiride compared with other second‐generation sulphonylureas among patients with type 2 diabetes in a real‐world clinical setting. Materials and methods We identified all sulphonylurea initiators between 1998 and 2017 in the UK Clinical Practice Research Datalink. Using a prevalent new‐user design, glimepiride initiators were matched 1:4 with initiators of other second‐generation sulphonylureas on calendar time, prior sulphonylurea use, and time‐conditional high‐dimensional propensity score. Cox proportional hazards models yielded adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for myocardial infarction, ischaemic stroke, severe hypoglycaemia, cardiovascular death, and all‐cause mortality. Results Among 66 032 sulphonylurea new users, 6438 initiated glimepiride and were matched to up to 20 582 initiators of other second‐generation sulphonylureas. During a mean follow‐up of 1.3 years, glimepiride was associated with a similar incidence of myocardial infarction (HR 0.99, 95% CI 0.75–1.30) and ischaemic stroke (HR 0.96, 95% CI 0.72–1.27) compared with other second‐generation sulphonylureas, while there was a non‐significant trend towards a higher incidence of severe hypoglycaemia (HR 1.24, 95% CI 0.92–1.68). Glimepiride was also associated with a lower incidence of all‐cause mortality (HR 0.77, 95% CI 0.67–0.89), and a non‐significant but similar trend for cardiovascular death (HR 0.83, 95% CI 0.65–1.05). Conclusions Glimepiride was associated with a lower incidence of all‐cause mortality compared with other second‐generation sulphonylureas.