Reid H Whitlock1, Ingrid Hougen2, Paul Komenda3, Claudio Rigatto3, Kristin K Clemens4, Navdeep Tangri5. 1. Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada. 2. Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. 3. Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. 4. Institute of Clinical Evaluative Sciences, London, ON, Canada; Division of Endocrinology, Department of Medicine, London, ON, Canada; Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; St. Joseph's Health Care London, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada. 5. Seven Oaks General Hospital, Chronic Disease Innovation Centre, Winnipeg, MB, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. Electronic address: ntangri@sogh.mb.ca.
Abstract
OBJECTIVE: To compare the safety of metformin vs sulfonylureas in patients with type 2 diabetes by chronic kidney disease (CKD) stage. PATIENTS AND METHODS: This retrospective cohort study included adults in Manitoba, Canada, with type 2 diabetes, an incident monotherapy prescription for metformin or a sulfonylurea, and a serum creatinine measurement from April 1, 2006, to March 31, 2017. Patients were stratified by estimated glomerular filtration rate (eGFR) into the following groups: eGFR of 90 or greater, 60 to 89, 45 to 59, 30 to 44, or less than 30 mL/min/1.73 m2. Outcomes included all-cause mortality, cardiovascular events, and major hypoglycemic episodes. Baseline characteristics were used to calculate propensity scores and perform inverse probability of treatment weights analysis, and eGFR group was examined as an effect modifier for each outcome. RESULTS: The cohort consisted of 21,996 individuals (19,990 metformin users and 2006 sulfonylurea users). Metformin use was associated with lower risk for all-cause mortality (hazard ratio [HR], 0.48; 95% CI, 0.40-0.58; P<.001), cardiovascular events (HR, 0.67; 95% CI, 0.52-0.86; P=.002), and major hypoglycemic episodes (HR, 0.14; 95% CI, 0.09-0.20; P<.001) when compared with sulfonylureas. CKD was a significant effect modifier for all-cause mortality (P=.002), but not for cardiovascular events or major hypoglycemic episodes. CONCLUSION: Sulfonylurea monotherapy is associated with higher risk for all-cause mortality, major hypoglycemic episodes, and cardiovascular events compared with metformin. Although the presence of CKD attenuated the mortality benefit, metformin may be a safer alternative to sulfonylureas in patients with CKD.
OBJECTIVE: To compare the safety of metformin vs sulfonylureas in patients with type 2 diabetes by chronic kidney disease (CKD) stage. PATIENTS AND METHODS: This retrospective cohort study included adults in Manitoba, Canada, with type 2 diabetes, an incident monotherapy prescription for metformin or a sulfonylurea, and a serum creatinine measurement from April 1, 2006, to March 31, 2017. Patients were stratified by estimated glomerular filtration rate (eGFR) into the following groups: eGFR of 90 or greater, 60 to 89, 45 to 59, 30 to 44, or less than 30 mL/min/1.73 m2. Outcomes included all-cause mortality, cardiovascular events, and major hypoglycemic episodes. Baseline characteristics were used to calculate propensity scores and perform inverse probability of treatment weights analysis, and eGFR group was examined as an effect modifier for each outcome. RESULTS: The cohort consisted of 21,996 individuals (19,990 metformin users and 2006 sulfonylurea users). Metformin use was associated with lower risk for all-cause mortality (hazard ratio [HR], 0.48; 95% CI, 0.40-0.58; P<.001), cardiovascular events (HR, 0.67; 95% CI, 0.52-0.86; P=.002), and major hypoglycemic episodes (HR, 0.14; 95% CI, 0.09-0.20; P<.001) when compared with sulfonylureas. CKD was a significant effect modifier for all-cause mortality (P=.002), but not for cardiovascular events or major hypoglycemic episodes. CONCLUSION:Sulfonylurea monotherapy is associated with higher risk for all-cause mortality, major hypoglycemic episodes, and cardiovascular events compared with metformin. Although the presence of CKD attenuated the mortality benefit, metformin may be a safer alternative to sulfonylureas in patients with CKD.
Authors: Anna Ostropolets; Pierre A Elias; Michael V Reyes; Elain Y Wan; Utpal B Pajvani; George Hripcsak; John P Morrow Journal: Circ Arrhythm Electrophysiol Date: 2021-02-07
Authors: Jiandong Zhou; Guoming Zhang; Carlin Chang; Oscar Hou In Chou; Sharen Lee; Keith Sai Kit Leung; Wing Tak Wong; Tong Liu; Abraham Ka Chung Wai; Shuk Han Cheng; Qingpeng Zhang; Gary Tse Journal: Acta Diabetol Date: 2022-02-03 Impact factor: 4.280
Authors: Marco Trevisan; Edouard L Fu; Yang Xu; Kitty Jager; Carmine Zoccali; Friedo W Dekker; Juan Jesus Carrero Journal: Clin Kidney J Date: 2020-12-14
Authors: Yao Hu; Min Lei; Guibao Ke; Xin Huang; Xuan Peng; Lihui Zhong; Ping Fu Journal: Front Endocrinol (Lausanne) Date: 2020-10-07 Impact factor: 5.555