(October 27, 2008 - Insidermedicine) Metformin may offer the most cardiovascular benefits among oral anti-diabetic drugs, but there is inadequate data to fully evaluate the long-term cardiovascular effects of these agents, according to a meta-analysis in the Archives of Internal Medicine.

Here are some recommendations regarding oral anti-diabetic agents:

•    If not contraindicated, metformin is the preferred initial oral agent for type 2 diabetes due to low cost, and low risk of hypoglycemia and side effects.

•    If metformin is contraindicated, sulfonylureas and glitazones are acceptable secondary choices.

•    Sulfonylureas are relatively inexpensive, and glitazones are contraindicated in congestive heart failure.

Researchers from Johns Hopkins conducted a meta-analysis of 40 clinical trials that explored the risks and benefits of oral medications for type 2 diabetes that are available in the U.S.

Treatment with metformin hydrochloride was linked with a reduced risk for cardiovascular mortality, compared with other oral agents or placebo, and there was also a trend toward reduced cardiovascular morbidity and all-cause mortality. Conversely, rosiglitazone was linked with an increased risk of cardiovascular morbidity and mortality, although these findings did not reach statistical significance. The authors acknowledged that available data on oral anti-diabetic agents is inadequate to fully evaluate their long-term cardiovascular health effects.

Today’s research highlights the need for better, long-term data on anti-diabetic drugs. Available data suggests that metformin may offer the most cardiovascular benefits.

For Insidermedicine in Depth, I'm Dr. Susan Sharma.