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DG DISPATCH - ACC: Metformin Outperforms Other Oral Agents In

Diabetics With Severe Coronary Disease

  " DG DISPATCH - ACC: Metformin Outperforms Other Oral Agents In

Diabetics With Severe Coronary Disease "

By Jill Stein

Special to DG News

ORLANDO, FL -- March 22, 2001 -- Diabetics who have coronary artery

disease (CAD) and are treated with the insulin sensitizer metformin have

improved survival rates compared to those treated with sulfonylureas or

insulin. This finding was reported at the 50th Annual Scientific Session

of the American College of Cardiology (ACC).

Dr. ph B. Muhlestein and colleagues at LDS Hospital in Salt Lake

City, Utah, prospectively followed 1,593 patients with diabetes and

severe CAD who underwent angiography to determine their long-term

clinical outcomes. Severe CAD was defined as a 70 percent or greater

stenosis in a major coronary vessel.

The investigators recorded the patients' baseline clinical, demographic,

and procedural characteristics as well as the diabetic medications

administered at hospital discharge. They then analyzed the rates of

death or myocardial infarction based on the anti-diabetic medication

strategy they had received at the time of hospital discharge.

Diabetic medications administered upon discharge were categorized as

follows: insulin only, a sulfonylurea (with or without insulin),

glitazone (with or without insulin or a sulfonylurea) and metformin

(with or without insulin, a sulfonylurea, or glitazone).

The mean age of the study population was 65 years, about two-thirds of

the patients were men.

Results showed that only 17 (8 percent) of 215 metformin-treated

patients died compared with seven (14 percent) of 52 patients who

received glitazone, 109 (16 percent) of 681 patients who received a

sulfonylurea, and 181 (28 percent) of 645 patients who received insulin

alone.

Further analysis revealed that the use of a sulfonylurea and insulin

alone predicted increased rates of death compared to metformin. The rate

of myocardial infarction did not differ between treatment groups.

" Although observational in nature, the results suggest that selecting an

insulin-sensitizing agent as first-line therapy in type 2 diabetics with

CAD may be beneficial, " Dr. Muhlestein suggested. He emphasized,

however, that this hypothesis needs to be verified in further studies.

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