Effect of Linagliptin vs Glimepiride on Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes

Abstract

When choosing medications to manage type 2 diabetes, cardiovascular safety, glucose-lowering potency, hypoglycemia risk, effect on body weight, and cost are important considerations.^1-3 Most guidelines state that metformin should be first-line therapy followed by various options for second-line treatment if sufficient glycemic control is not achieved after metformin monotherapy.^1-3 Sulfonylureas and dipeptidyl peptidase-4 (DPP-4) inhibitors are the most commonly used second-line glucose-lowering treatments in many countries.⁴ Sulfonylureas are used mainly based on their low cost, well-established glucose-lowering action, and a long-standing experience in clinical practice. However, sulfonylureas are associated with increased risk of hypoglycemia^1,3,5-7 and modest weight gain.^1,5 In addition, there is an ongoing controversy regarding their long-term cardiovascular safety, based on early data from the University Group Diabetes Program in the 1960s⁸ and multiple observational and smaller studies indicating conflicting results.^9,10