Research Article

Three-year mortality in diabetic patients treated with different combinations of insulin secretagogues and metformin

  1. Matteo Monami,
  2. Chiara Luzzi,
  3. Caterina Lamanna,
  4. Veronica Chiasserini,
  5. Filomena Addante,
  6. Carla Maria Desideri,
  7. Giulio Masotti,
  8. Niccolò Marchionni,
  9. Edoardo Mannucci*

Article first published online: 24 APR 2006

DOI: 10.1002/dmrr.642

Issue

Diabetes/Metabolism Research and Reviews

Diabetes/Metabolism Research and Reviews

Volume 22, Issue 6, pages 477–482, November/December 2006

Additional Information

How to Cite

Monami, M., Luzzi, C., Lamanna, C., Chiasserini, V., Addante, F., Desideri, C. M., Masotti, G., Marchionni, N. and Mannucci, E. (2006), Three-year mortality in diabetic patients treated with different combinations of insulin secretagogues and metformin. Diabetes/Metabolism Research and Reviews, 22: 477–482. doi: 10.1002/dmrr.642

Author Information

  1. Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence, Florence, Italy

*Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence and Azienda Ospedaliera Careggi, Via delle Oblate 4: 50134 Florence, Italy.

Publication History

  1. Issue published online: 20 OCT 2006
  2. Article first published online: 24 APR 2006
  3. Manuscript Accepted: 25 FEB 2006
  4. Manuscript Revised: 9 JAN 2006
  5. Manuscript Received: 23 NOV 2005

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Keywords:

  • diabetes mellitus;
  • insulin secretagogues;
  • metformin;
  • mortality

Abstract

Background

Several studies have shown an increase of mortality in diabetic patients treated with combinations of sulphonylureas and biguanides. Comparisons between different insulin secretagogues in combination with metformin with respect to all-cause mortality have not been reported so far.

Methods

An observational cohort study was performed on a consecutive series of 2002 outpatients with type 2 diabetes mellitus. Of these patients, 696 (34.8%) were receiving combinations of insulin secretagogues and biguanides at enrolment. Three-year mortality was assessed through research in the City of Florence Registry Office.

Results

During follow-up, 295 deaths were recorded. Among patients on combined secretagogue and biguanide treatment, glibenclamide was associated with a significantly higher yearly mortality (8.7%) than repaglinide (3.1%; p = 0.002), gliclazide (2.1%; p = 0.001), and glimepiride (0.4%; p < 0.0001). After adjusting for potential confounders (including age; duration of diabetes; Body Mass Index (BMI); lipid profile; HbA1c; insulin treatment; metformin doses; Charlson co-morbidity score; CCS), mortality remained significantly higher in patients treated with combinations of glibenclamide and metformin when compared to those treated with different insulin secretagogues (OR with 95% CI: 2.09 [1.07;4.11]).

Conclusions

In the present study, sulphonylureas with greater selectivity for β-cell receptors, such as glimepiride and gliclazide, were associated with a lower mortality when used in combination with metformin in comparison with glibenclamide. Safety of such combinations deserves further investigation. Copyright © 2006 John Wiley & Sons, Ltd.

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