The annual meeting of the European Association for the Study of Diabetes was held in Barcelona, Spain in September. Highlights of the research presented at the meeting include:
Patients whose first-line therapy for type 2 diabetes was a sulfonylurea had significantly increased risk of death compared to those on metformin monotherapy, according a retrospective analysis of data from the United Kingdom. The analysis included almost 100,000 patients (more than 15,000 of them on sulfonylureas), and the increased mortality in the sulfonylurea patients persisted even in the direct- and propensity-matched cohorts. While noting that confounding could have occurred, the researchers concluded “treatment with first-line monotherapy with sulfonylureas should be reconsidered.”
In the Veterans Administration system, many patients with cardiovascular risks are taking sulfonylureas, despite guidelines to the contrary, a retrospective cohort study found. Analyzing records from almost 150,000 patients, researchers found that a quarter of patients with existing cardiovascular disease or multiple cardiovascular risk factors were taking drugs in the class, about the same rate as patients at low risk of cardiovascular disease.
Use of pioglitazone was associated with development of diabetic macular edema (DME), according to a retrospective study using 2000 to 2011 data from a Japanese database. More than 20,000 type 2 diabetes patients were included, and of the 953 taking pioglitazone, the rate of DME was 1.5% compared to 0.45% in the overall group, leading researchers to conclude that pioglitazone may increase the risk of DME.
Delay in intensifying treatment of type 2 diabetes was associated with higher risk of cardiovascular events, a retrospective analysis found. More than 110,000 patients were studied, more than a quarter of whom had a hemoglobin A1c of 7% or higher a year after diabetes diagnosis. Patients in that group who didn't intensify treatment (addition of a second oral drug or insulin) within a year were significantly more likely to have a myocardial infarction, stroke or heart failure during study follow-up, supporting the cardiovascular benefits of early treatment intensification in patients with poor glycemic control, researchers concluded.
Erectile dysfunction in men with type 1 diabetes often reverses itself, especially after a short duration, according to new data from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications. More than 700 men were queried about impotence. Of the 198 with a single report of erectile dysfunction (ED), 67.7% regained potency within 5 years. The likelihood of regaining potency decreased with every consecutive year of ED, until those with 5 or more consecutive years had less than a 20% chance. The overall incidence of ED increased from 5.5% in first year (1994) of follow up, to 33.6% by year 16 (2009).