Cardiovascular benefits of incretinsBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4382 (Published 10 July 2013) Cite this as: BMJ 2013;347:f4382
- Anthony H Barnett, emeritus professor of medicine and consultant physician1,
- Paul O’Hare, reader in medicine and honorary consultant physician2
- 1Heart of England NHS Foundation Trust and University of Birmingham, Diabetes Centre, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK
- 2Warwick Medical School, University of Warwick, Coventry, UK
Cohen and colleagues make no mention of the evidence that treatment of type 2 diabetes with increasingly larger doses of sulfonylureas and insulin is not without serious risk from hypoglycaemia, weight gain, and possibly increased cardiovascular risk.1 A balanced account of this is needed in any review of incretins.
There have been concerns that such treatments, or the hypoglycaemia and weight gain they produce, explain failure to reduce cardiovascular disease despite tightening glycaemic control. Large meta-analyses of sulfonylureas suggest that they may increase cardiovascular risk.2 3 By contrast, a large meta-analysis of dipeptidyl peptidase 4 inhibitors suggests significant cardiovascular benefit.4 …