Metformin, the first-line drug of choice for controlling type 2 diabetes, has performed favorably in a study comparing its long-term risks with those of individual insulin secretagogues (ISs).

In Denmark, Dr. Tina Ken Schramm and colleagues followed 107,806 persons who had been treated with either an IS or metformin between 1997 and 2006. Although ISs, particularly sulfonylurea, are linked with a reduction in long-term risk for death from any cause and risks of MI, stroke, or death from cardiovascular diseases, metformin appears to be even safer.

Compared with glimepiride, glyburide, glipizide, and tolbutamide monotherapy, treatment with metformin demonstrated a lower risk of death from any cause, and a lower risk of heart attack, stroke, or death from cardiovascular disease for patients with or without a history of MI. The ISs repaglinide and gliclazide did not differ significantly from metformin in their effectiveness in persons with or without a history of MI.

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In a statement announcing the study results, which were published online by European Heart Journal, Dr. Schramm explained that the increased risk from ISs “presumably has more to do with the beneficial effects of metformin, gliclazide, and repaglinide, than the detrimental effect of the other ISs,” which are associated with a reduction in long-term risk.

The FDA has just approved Tradjenta (linagliptin) to improve blood-glucose control in people with type 2 diabetes as an adjunct to diet and exercise. This dipeptidyl peptidase-4 inhibitor increases the level of hormones that stimulate the release of postprandial insulin.