This meta-analysis suggests a possible beneficial effect of DPP-4 inhibitors on cholesterol, which, although small, could contribute to the reduction of cardiovascular risk.

In the present study, sulphonylureas with greater selectivity for beta-cell receptors, such as glimepiride and gliclazide, were associated with a lower mortality when used in combination with metformin in comparison with glibenclamide. Safety of such combinations deserves further investigation.

Objective. Data from randomized clinical trials with metabolic outcomes can be used to address concerns about potential issues of cardiovascular safety for newer drugs for type 2 diabetes. This meta-analysis was designed to assess cardiovascular safety of GLP-1 receptor agonists. Design and Methods. MEDLINE, Embase, and Cochrane databases were searched for randomized trials of GLP-1 receptor agonists (versus placebo or other comparators) with a duration ≥12 weeks, performed in type 2 diabetic patients. Mantel-Haenszel odds ratio with 95% confidence interval (MH-OR) was calculated for major cardiovascular events (MACE), on an intention-to-treat basis, excluding trials with zero events. Results. Out of 36 trials, 20 reported at least one MACE. The MH-OR for all GLP-1 receptor agonists was 0.74 (0.50–1.08), P = .12 (0.85 (0.50–1.45), P = .55, and 0.69 (0.40–1.22), P = .20, for exenatide and liraglutide, resp.). Corresponding figures for placebo-controlled and active comparator studies were 0.46 (0.25–0.83), P = .009, and 1.05 (0.63–1.76), P = .84, respectively. Conclusions. To date, results of randomized trials do not suggest any detrimental effect of GLP-1 receptor agonists on cardiovascular events. Specifically designed longer-term trials are needed to verify the possibility of a beneficial effect.

OBJECTIVE -To assess the relevance of pulse pressure as a predictor of foot ulcers in type 2 diabetic subjects.RESEARCH DESIGN AND METHODS -A cohort study was performed on a consecutive series of 1,945 type 2 diabetic outpatients without a foot ulcer at baseline. Incident foot ulcers were identified through the regional hospital discharge system, which contains ICD codes of current diagnoses.RESULTS -During a follow-up of mean Ϯ SD 4.2 Ϯ 2.2 years, 86 ulcers were observed. After adjusting for confounders, the highest quartiles of pulse pressure had a 2.39-fold (95% CI 1.14 -5.02) risk of foot ulcers. When ischemic ulcers were considered separately, the highest pulse pressure quartile was associated with an increased age-and sex-adjusted risk (2.08 [95% CI 1.02-4.24]), whereas no increase of risk was observed for neuropathic ulcers.CONCLUSIONS -Elevated pulse pressure represents an independent predictor of foot ulcers in diabetic patients; this parameter should be considered for the stratification of risk of ischemic or neuroischemic ulcers.