Not All Diabetes Medications Reduce Mortality Risk

Highlights

One class of diabetic drugs - DPP-4 inhibitor drugs were found to have no effect on the mortality risk of patients, when compared to the other diabetic medications.
Sodium-glucose cotransporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) agonists were found to decrease the mortality risk by 20 and 18 percent.
Previous studies have suggested that DPP-4 inhibitor drugs are currently prescribed to at least one in three people with type 2 diabetes.

While all the drugs reduced blood sugar levels, dipeptidyl peptidase 4 (DPP-4) inhibitors among sodium-glucose cotransporter 2 (SGLT-2) inhibitors, glucagon-like peptide 1 (GLP-1) agonists did not reduce mortality risk, finds a new study. The findings of this study are published in the journal of JAMA.

Studies in the past have indicated that these medications are very common and are currently given to at least one in three people with type 2 diabetes.

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‘While SGLT-2 inhibitor and GLP-1 agonist drugs have decreased the risk of mortality by 20 and 18 percent, DPP-4 inhibitor drugs have not decreased the mortality risk by anything. Patients were better off the mortality risk with SGLT-2 and GLP-1 agonist medications.’

The main aim of the study is to find out which of these three drugs- Sodium-glucose cotransporter 2 (SGLT-2) inhibitors, glucagon-like peptide 1 (GLP-1) agonists, and DPP-4 inhibitor drugs can reduce mortality risk. They conducted this study on a meta-analysis network of 236 trials comparing all the drugs against each other, a placebo and a no treatment at all option. The study involved 176,310 patients.

Though all drugs are well known to decrease blood sugar levels, they might not be known for their mortality reduction behavior. In the study, only two drugs were found to decrease the risk of death when compared with a placebo.

SGLT-2 inhibitor and GLP-1 agonist drugs were found to decrease the mortality risk by 20 and 18 percent compared to patients taking an inactive placebo pill, or no medication at all.

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However, the DPP-4 inhibitor drugs did not decrease the risk of death compared to the other two drugs. There was also no significant difference between the SGLT-2 inhibitor plus GLP-1 agonist drugs mortality risk-reducing capacities compared to each of the drugs.

"Type 2 diabetes has become a global epidemic, with more cases than ever before. The three drug classes assessed here are being increasingly prescribed, yet until now there have been no clinical trials studying how these drugs compare to each other, and which type of drug could be the best option for patients," said Dr. Sean Zheng, the lead author of the study.

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Even though Type 2 diabetes affects 422 million people worldwide, people prefer taking medications compared to exercise or restraint. Metformin is the most commonly prescribed drugs for this condition but if this doesn’t work patients are usually offered other drugs such as SGLT-2 inhibitors, GLP-1 agonists and DPP-4 inhibitors.

"Patients with type 2 diabetes are at higher risk of dying from heart attacks or strokes, so we wanted to investigate which of these three treatments are most efficient at preventing death and cardiovascular diseases. Our hope is that in the crowded market that is diabetes medications, patients and their doctors have the necessary information to allow them to make informed decisions about long-term treatment strategies," said Dr. Zheng. As all these do the same work of lowering blood sugar levels, doctors so far were unclear if one drug was more effective than the other, explained Dr. Zheng.

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To get the results the team studied all randomized-controlled trials- which randomly assigned patients to a drug or a placebo pill, or no drug at all and compared the treatment drug with each other. The results that were found indicated that DPP-4 inhibitor drugs were not associated with a reduced risk of death, whereas SGLT-2 inhibitor and GLP-1 agonist medications were linked to a 1 and 0.6 percent decrease in absolute risk of death.

People taking GLP-1 medication were associated with a 15 percent drop in cardiovascular risk event with an absolute risk reduction of 0.5 percent, while people taking SGLT-2 inhibitor drugs were associated with a 21 percent reduction in risk of dying specifically from a heart attack or stroke (absolute risk of 0.8 percent).

SGLT-2 inhibitor drugs were also associated with significant reduction in risk of heart failure compared with both the other treatments. There was no reduction in mortality risk from a cardiovascular event for the drugs DPP-4 inhibitors.

Further research needs to be done to confirm these findings, and Dr. Zheng also stressed that anyone concerned about their drug regimen should consult their doctors. As these drugs are relatively new, most trials were only able to track patients for a few years.

Source-Medindia