Rury R. Holman, F.R.C.P. (click here for full article).
Methods: 5102 patients with newly diagnosed type 2 diabetes, 4209 were randomly assigned to receive either conventional therapy (dietary restriction) or intensive therapy (either sulfonylurea or insulin or, in overweight patients, metformin) for glucose control.
Results: Between-group differences in glycated hemoglobin levels were lost after the first year.
In the sulfonylurea–insulin group, relative reductions in risk persisted at 10 years for any diabetes-related end point (9%, P=0.04) and microvascular disease (24%, P=0.001), and risk reductions for myocardial infarction (15%, P=0.01) and death from any cause (13%, P=0.007) emerged over time, as more events occurred.
In the metformin group, significant risk reductions persisted for any diabetes-related end point (21%, P=0.01), myocardial infarction (33%, P=0.005), and death from any cause (27%, P=0.002).
From table 2: It's interesting that with metformin there is no significant risk reduction in microvascular disease (0.60-1.17), but there is in the sulfonylurea-insulin group (0.64-0.89). All other outcomes are similar with respect to significance. Does it follow then that the sulfonylurea/insulin class is the better class?
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