Case-control study of second-line therapies for type 2 diabetes in combination with metformin and the comparative risks of myocardial infarction and stroke Academic Article uri icon


MeSH Major

  • Diabetes Mellitus, Type 2
  • Hypoglycemic Agents
  • Insulin
  • Metformin
  • Myocardial Infarction
  • Stroke
  • Sulfonylurea Compounds


  • We conducted a population-based case-control study to assess the myocardial infarction (MI) and stroke risks associated with sulphonylureas and insulin when used in combination with metformin. Cases had type 2 diabetes and used metformin + insulin or metformin + sulphonylureas at the time of a first MI or first stroke between 1995 and 2010; controls used the same treatment combinations and were randomly sampled from the same population. MI and stroke diagnoses and potential confounders were validated by medical record reviews. Compared with metformin + sulphonylurea, metformin + insulin was associated with similar risks of MI or stroke [odds ratio 0.98 (95% confidence interval 0.63-1.52)]. Meta-analysis with another observational study improved the precision of the risk estimate [relative risk 0.92 (95% confidence interval 0.69-1.24)]. Current evidence suggests that there may not be large differences in cardiovascular risk associated with the use of insulin or sulphonylureas when used in combination with metformin.

publication date

  • January 2015



  • Academic Article


Digital Object Identifier (DOI)

  • 10.1111/dom.12537

PubMed ID

  • 26179389

Additional Document Info

start page

  • 1194

end page

  • 7


  • 17


  • 12