Diabetes, Heart and Cardiovascular Diseases News Chronicle.  Diabetes, Cardiovascular and Heart Diseases
 Article 300
    Published on February 2, 2018

 

Patients Of Type 2 Diabetes With Chronic Kidney Disease May Survive Longer With Metformin

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An observational and the national cohort study shows 36 percent of the lower risk of death (mortality) in the patients of type 2 diabetes with a chronic kidney disease (CKD) by starting the metformin treatment compared with patients starting with the sulfonylurea drug treatment. The study also shows that patients of type 2 diabetes with a chronic kidney disease (also called chronic renal failure. CRF) may survive longer with metformin.



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Metformin can cause a lower risk of death (mortality) in a patient of type 2 diabetes with a chronic kidney disease.

An observational study was done between 2004 and 2009 on 175,296 veterans who received at least one-year treatment from the Veterans Health Administration (VHA), a part of the United States Department of Veterans Affairs (VA). After receiving the treatment from the VHA, all of them were under a monotherapy (usage of a single drug) for the treatment of type 2 diabetes with either sulfonylurea or metformin. The study shows.

  • A death of 5,121 individuals.
  • Those individuals under the treatment with the metformin (monotherapy) had 36 percent of the lower risk of death (mortality) compared with those individuals under the treatment with the sulfonylurea (monotherapy).
  • The amount of risk reduction varies with the estimated glomerular filtration rate (eGFR).
  • The largest absolute risk reduction was observed in the patients with a moderate to severe reduction in eGFR.
  • The researchers did not find the risk of serious acidosis in patients with chronic kidney diseases (CKD) with an eGFR between 30 and 45 mL/min/1.73m2.

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The following table shows the risk reduction among patients with type 2 diabetes with a chronic kidney disease (CKD) who started with metformin compared with those patients who started with the sulfonylureas.



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eGFR (mL/min/1.73m2) Risk reduction Fewer deaths per
1000 person-years
Equal to or more than 90 41 percent 3.0
Between 60 and 89   4.3
Between 45 and 59 20 percent 3.4
Between 30 and 44 Greatest risk reduction 12.1

The FDA guidance advises the initiation of metformin for the patients of type 2 diabetes with an estimated glomerular filtration rate (eGFR) between 45 and 59 mL/min/1.73m2. The FDA also suggests that patients of type 2 diabetes with a severe kidney disease would be benefited with the initiation of metformin. This study supports the current FDA guidance.

The lead author of the study was James S. Floyd, MD, the University of Washington, Seattle, the United States. The study was published on November 27, 2017, in the Journal of General Internal Medicine. Title of the article was "Mortality Associated with Metformin Versus Sulfonylurea Initiation: A Cohort Study of Veterans with Diabetes and Chronic Kidney Disease."
DOI: doi.org/10.1136/bmjopen-2012-001076



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