(P-323) Risk of Cardiovascular Diseases Associated with Sulfonylurea as an Add-on Therapy to Metformin in Patients with Type 2 Diabetes Mellitus

Background: Sulfonylurea (SU) as an add-on therapy to metformin in patients with type 2 diabetes mellitus (T2DM) is one of the extensively prescribed hypoglycemic agents. Recently, SU has been controversial over cardiovascular safety, and results from previous studies have not been consistent with each other.

Objectives: The study aimed to assess the risk of cardiovascular diseases with SU use as an add-on therapy to metformin in patients with T2DM compared to dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, and thiazolidinedione (TZD).

Methods: We conducted a retrospective cohort study using the National Health Insurance Service (NHIS) from 2011 to 2018 in Korea. Patients aged ≥40 years and those diagnosed with T2DM prior to drug prescription were enrolled in this study. The outcome was cardiovascular disease. Primary analysis was performed using Cox’s proportional hazard model after 1:1 propensity score (PS) matching to calculate the hazard ratio (HR) with 95% confidence interval (CI).

Results: A total of 63,826, 7,060, 8,223 patients were assigned to the DPP-4 inhibitors, SGLT-2 inhibitors, TZD comparator groups, respectively. There was not associated with the SU use and the risk of cardiovascular disease than DPP-4 inhibitors (HR: 1.02, 95% CI: 0.99–1.04), TZD (HR: 1.01, 95% CI: 0.95-1.08) and SGLT-2 inhibitors (HR: 0.83, 95% CI: 0.77-0.89) as an add-on therapy to metformin.

Conclusions: SU was not associated with a significantly increased risk of cardiovascular diseases. However, the incidence of cardiovascular disease increases with age, it is necessary to closely monitor when prescribing the SU in elderly patients with T2DM.