Risk of Death and Heart Failure among Patients with Type 2 Diabetes Treated by Metformin and Non metformin Monotherapy: A Real-World Study

Type 2 diabetes mellitus is characterized by insulin resistance and pancreatic beta-cell dysfunction. China has the largest type 2 diabetes population. Metformin has been recommended as the first-line medication for the management of type 2 diabetes in several guidelines by UKPDS. However, in China, metformin is less frequently used than sulfonylureas because, of the low price and high availability of sulfonylureas as well as the rumour that metformin may have severe liver and kidney damage. Type 2 diabetes has been recognized as a major risk factor for cardiovascular disease.

Diabetics have a high prevalence of common risk factors for cardiovascular disease, such as obesity and dyslipidemia. Glycemic control has been shown to have a favorable influence on macrovascular complications in the long run. The efficacy of metformin, one of the most used hypoglycemic drugs, in improving glycemic control has long been established. Metformin delivers its protective effects against cardiovascular disease with established cardiovascular. Siyao He conducted study titled “Risk of Death and Heart Failure among Patients with Type 2 Diabetes Treated by Metformin and Nonmetformin Monotherapy: A Real-World Study” published in Journal of Diabetes Research.

Objective:

To assess the association of metformin monotherapy with the risk of all-cause deaths and cardiovascular deaths and events in type 2 diabetes patients in real clinical practice.

Methods:

Health record data was pooled from the NHBD database in Fuzhou, Fujian Province, China. from September 2001 to January 2018. Demographics, medical history, laboratory measures, prescription data, and other clinical information generated from healthcare service were recorded in the database.

Findings:

The study evaluated and compared the protective effect of metformin versus nonmetformin towards cardiovascular events and all-cause death in real clinical practice. The findings showed greater reduction in macrovascular and microvascular complications, stroke, and all-cause mortality than those who received other medications.
The benefit of metformin use extends beyond cardiovascular disease prevention. Research studies has suggested a protective effect of metformin against the development of, which to some extent explains the observed larger reduction in cumulative incidence of all-cause death than cardiovascular death alone among those treated with metformin.
In conclusion metformin as first-line monotherapy greatly reduced the risk of all-cause death, cardiovascular death, and heart failure in diabetes patients as compared with nonmetformin medications.

Limitations:

The baseline characteristics between the metformin and nonmetformin groups were substantially different; Limited variables collected in real clinical practice, Patients with cancer or chronic inflammatory diseases were not excluded from the analysis, Limited data available on SGLT2 inhibitors and GLP.

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