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

 

Type 2 diabetes patients with chronic kidney diseases can survive longer with metformin

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



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The lower risk of death (mortality) in type 2 diabetes patients with chronic kidney diseases (or renal failure. CRF).

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.

  • Death of 5,121 individuals.
  • Individuals with the metformin (monotherapy) had 36 percent the lower risk of death (mortality) compared with individuals 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 patients with a moderate to severe reduction in eGFR.
  • Researchers did not find the risk of serious acidosis in patients with chronic kidney diseases (CKD) with eGFR between 30 and 45 mL/min/1.73m2.

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


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


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Lead author of the study was James S. Floyd, MD, the University of Washington, Seattle, the United States. The study was published 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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