José Gerardo González-González1, Ricardo Cesar Solis2, Alejandro Díaz González-Colmenero2, Karina Raygoza-Cortez2, Pablo J Moreno-Peña2, Alicia L Sánchez2, Rozalina G McCoy3, Naykky Singh Ospina4, Spyridoula Maraka5, Juan P Brito6, René Rodriguez-Gutierrez7. 1. Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autonoma de Nuevo León, Monterrey 64460, Mexico. 2. Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico. 3. Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA. 4. Division of Endocrinology, Department of Medicine, University of Florida, FL 32610, USA. 5. Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Central Arkansas Veterans Healthcare System, Medicine Service, Little Rock, AR, USA. 6. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA. 7. Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autonoma de Nuevo León, Monterrey 64460, Mexico; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA. Electronic address: rodriguezgutierrez.rene@mayo.edu.
Abstract
AIMS: Examine the efficacy of metformin compared to placebo or other glucose-lowering medications on microvascular outcomes in patients with Type 2 Diabetes Mellitus (T2DM). METHODS: MEDLINE, EMBASE, Web of Science, and Scopus were searched from database inception to March 2020. We included randomized clinical trials of patients with T2DM receiving metformin compared with another active glucose-lowering treatment or placebo in which a microvascular outcome was assessed. The risk of bias was assessed using the Cochrane Risk of Bias tool. Microvascular complications included kidney-related outcomes, retinopathy, and peripheral neuropathy. An inverse-weighted variance random-effect meta-analysis was performed to estimate drugs effect over microvascular disease. PROSPERO (CRD42019120365). RESULTS: Nineteen RCTs (n = 18,181) were included. Metformin increased estimated glomerular filtration rate (eGFR) by a mean difference (MD) of 1.08 (95% CI 0.84 to 1.33 ml/min/1.73 m2) after 24 weeks. No effect was found on urinary albumin-creatinine ratio, serum creatinine, and end-stage kidney disease; Patient-important outcomes regarding kidney disease, retinal outcomes, peripheral neuropathy or quality of life were not assessed by any of the included studies and could not be analyzed. CONCLUSIONS: There is no evidence of clinically significant beneficial effect of metformin therapy as compared to other glucose-lowering medications or placebo on the examined microvascular complications.
AIMS: Examine the efficacy of metformin compared to placebo or other glucose-lowering medications on microvascular outcomes in patients with Type 2 Diabetes Mellitus (T2DM). METHODS: MEDLINE, EMBASE, Web of Science, and Scopus were searched from database inception to March 2020. We included randomized clinical trials of patients with T2DM receiving metformin compared with another active glucose-lowering treatment or placebo in which a microvascular outcome was assessed. The risk of bias was assessed using the Cochrane Risk of Bias tool. Microvascular complications included kidney-related outcomes, retinopathy, and peripheral neuropathy. An inverse-weighted variance random-effect meta-analysis was performed to estimate drugs effect over microvascular disease. PROSPERO (CRD42019120365). RESULTS: Nineteen RCTs (n = 18,181) were included. Metformin increased estimated glomerular filtration rate (eGFR) by a mean difference (MD) of 1.08 (95% CI 0.84 to 1.33 ml/min/1.73 m2) after 24 weeks. No effect was found on urinary albumin-creatinine ratio, serum creatinine, and end-stage kidney disease; Patient-important outcomes regarding kidney disease, retinal outcomes, peripheral neuropathy or quality of life were not assessed by any of the included studies and could not be analyzed. CONCLUSIONS: There is no evidence of clinically significant beneficial effect of metformin therapy as compared to other glucose-lowering medications or placebo on the examined microvascular complications.
Authors: Nisa M Maruthur; Eva Tseng; Susan Hutfless; Lisa M Wilson; Catalina Suarez-Cuervo; Zackary Berger; Yue Chu; Emmanuel Iyoha; Jodi B Segal; Shari Bolen Journal: Ann Intern Med Date: 2016-04-19 Impact factor: 25.391
Authors: Yehuda Handelsman; Zachary T Bloomgarden; George Grunberger; Guillermo Umpierrez; Robert S Zimmerman; Timothy S Bailey; Lawrence Blonde; George A Bray; A Jay Cohen; Samuel Dagogo-Jack; Jaime A Davidson; Daniel Einhorn; Om P Ganda; Alan J Garber; W Timothy Garvey; Robert R Henry; Irl B Hirsch; Edward S Horton; Daniel L Hurley; Paul S Jellinger; Lois Jovanovič; Harold E Lebovitz; Derek LeRoith; Philip Levy; Janet B McGill; Jeffrey I Mechanick; Jorge H Mestman; Etie S Moghissi; Eric A Orzeck; Rachel Pessah-Pollack; Paul D Rosenblit; Aaron I Vinik; Kathleen Wyne; Farhad Zangeneh Journal: Endocr Pract Date: 2015-04 Impact factor: 3.443
Authors: Johannes F E Mann; David D Ørsted; Kirstine Brown-Frandsen; Steven P Marso; Neil R Poulter; Søren Rasmussen; Karen Tornøe; Bernard Zinman; John B Buse Journal: N Engl J Med Date: 2017-08-31 Impact factor: 91.245
Authors: Dick de Zeeuw; Giuseppe Remuzzi; Hans-Henrik Parving; William F Keane; Zhongxin Zhang; Shahnaz Shahinfar; Steve Snapinn; Mark E Cooper; William E Mitch; Barry M Brenner Journal: Kidney Int Date: 2004-06 Impact factor: 10.612
Authors: Markolf Hanefeld; Paolo Brunetti; Guntram H Schernthaner; David R Matthews; Bernard H Charbonnel Journal: Diabetes Care Date: 2004-01 Impact factor: 19.112
Authors: E G Dorsey-Treviño; J G González-González; N Alvarez-Villalobos; V González-Nava; B M Contreras-Garza; A Díaz González-Colmenero; G Rodríguez-Tamez; F J Barrera-Flores; A M Farrell; V M Montori; R Rodriguez-Gutierrez Journal: J Endocrinol Invest Date: 2019-09-05 Impact factor: 4.256