Diabetes, Heart and Cardiovascular Diseases News Chronicle. Diabetes, Cardiovascular and Heart Diseases. Article 300
Published on February 2, 2018 at 5:30 PM GMT


 



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

Reduced death mortality risk in diabetic patients with chronic kidney diseases CKD renal failure CRF.

An observational and national cohort study done by researchers shows 36 percent decrease in the risk of death or mortality among type 2 diabetes (T2D) patients with chronic kidney diseases (CKD) by starting metformin treatment compared with those patients starting with sulfonylurea treatment. This means diabetic patients with chronic kidney diseases (also called chronic renal failure CRF) may survive longer with metformin drug.



Researchers have conducted studies among 175,296 veterans. All individuals have 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 treatment from VHA, all of them were under monotherapy (usage of a single drug) for the treatment of type 2 diabetes with either sulfonylurea or metformin between 2004 and 2009. The study findings show.

  • Researchers have found the death of 5,121 individuals.
  • Individuals starting with a metformin monotherapy medication had 36 percent reduced the risk of death or mortality compared with individuals starting with a sulfonylurea monotherapy medication.
  • The amount of risk reduction varies by estimated glomerular filtration rate (eGFR).
  • The largest absolute risk reduction was observed among patients with a moderate to severely reduced eGFR.
  • Researchers did not find the risk of acidosis/serious infection even in CKD patients with eGFR between 30 and 45 mL/min/1.73m2.

Following table describes the risk reduction among type 2 diabetes patients with chronic kidney diseases (CKD) who started metformin compared with those started 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


FDA guidance advises metformin drug initiation among type 2 diabetes patients with estimated glomerular filtration rate (eGFR) of 45 to 59 mL/min/1.73m2. FDA also suggests type 2 diabetes patients with severe CKD will be benefited with metformin drug initiation. This study supports current FDA guidance.

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