Objective:
To compare the 5-year risk of major adverse cardiovascular events (MACE-4) associated with glipizide versus dipeptidyl peptidase 4 inhibitors in adults with type 2 diabetes and moderate cardiovascular risk.
Approach:
- Study Design: A nationwide comparative effectiveness study including 48,165 adults aged 30 years or older who received metformin monotherapy for at least 3 months.
- Participants: Participants were treated at 10 US health systems or insured by 2 national health plans between 2014 and 2023.
- Treatment Groups: Participants initiated glipizide (18,147), glimepiride (14,282), glyburide (1,887), or DPP4 inhibitors (13,849).
- Follow-Up: Median follow-up was 37 months with a median treatment duration of 13 months for glipizide.
Key Findings:
- Glipizide was associated with a 13% higher 5-year risk of MACE-4 compared to DPP4 inhibitors.
- Estimated 5-year risks of MACE-4 were 9% for glipizide, 8.6% for glimepiride, 8.4% for glyburide, and 8% for DPP4 inhibitors.
- Among participants aged 65 years or older, the 5-year MACE-4 risk was 15% for glipizide compared to 13% for DPP4 inhibitors.
- Component risks for glipizide users included 3% for myocardial infarction, 4% for ischemic stroke, and 4% for heart failure hospitalization.
Interpretation:
Limitations:
- Residual confounding by treatment indication.
- Median follow-up of just over 3 years.
- Limited generalizability due to a predominantly privately insured population.
- Absence of dose-specific analyses.
Conclusion:
Sources:
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