Association between first‐line monotherapy with sulphonylurea versus metformin and risk of all‐cause mortality and cardiovascular events: a retrospective, observational study

Morgan, C. Ll.; Mukherjee, Jayanti; Jenkins‐Jones, Sara; Holden, Sarah E.; Currie, Craig John

doi:10.1111/dom.12302

Cited by 65 publications

(45 citation statements)

References 24 publications

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“…Observational data regarding the rate of heart failure with the use of SUs has been mixed, with two studies (25,26) finding an association between SU treatment and an increased rate of heart failure compared with metformin treatment, and one study (27) finding no association between SU treatment and heart failure in the context of a case-control analysis compared with no SU exposure. Beyond heart failure, the increased risk of other cardiovascular events with SU therapy is better established in clinical trials (28) and observational studies (29,30). In agreement with our results, these prior studies found that DPP-4i therapy was often associated with a reduced rate of cardiovascular events compared with SU therapy.…”

Section: Discussionsupporting

confidence: 91%

Association Between Hospitalization for Heart Failure and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes: An Observational Study

Johnston

Ghannam

et al. 2016

Diabetes Care

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OBJECTIVETo examine, among patients with type 2 diabetes, the association between hospitalization for heart failure (hHF) and treatment with dipeptidyl peptidase 4 inhibitors (DPP-4is) versus sulfonylureas (SUs), and treatment with saxagliptin versus sitagliptin. RESEARCH DESIGN AND METHODSThis was a retrospective, observational study using a U.S. insurance claims database. Patients initiated treatment between 1 August 2010 and 30 August 2013, and had no use of the comparator treatments in the prior 12 months (baseline). Each comparison consisted of patients matched 1:1 on a propensity score. Time to each outcome was compared between matched groups using Cox models. Analyses were stratified by the presence of baseline cardiovascular disease (CVD). Secondary analyses examined associations between comparator treatments and other selected cardiovascular events. RESULTSAfter matching, the study included 218,556 patients in comparisons of DPP-4i and SU, and 112,888 in comparisons of saxagliptin and sitagliptin. The hazard ratios (HRs) of hHF were as follows: DPP-4i versus SU (reference): HR 0.95 (95% CI 0.78-1.15), P = 0.580 for patients with baseline CVD; HR 0.59 (95% CI 0.38-0.89), P = 0.013 for patients without baseline CVD; saxagliptin versus sitagliptin (reference): HR 0.95 (95% CI 0.70-1.28), P = 0.712 for patients with baseline CVD; HR 0.99 (95% CI 0.56-1.75), P = 0.972 for patients without baseline CVD. Comparisons of the individual secondary and composite cardiovascular outcomes followed a similar pattern. CONCLUSIONSIn patients with type 2 diabetes, there was no association between hHF, or other selected cardiovascular outcomes, and treatment with a DPP-4i relative to SU or treatment with saxagliptin relative to sitagliptin.

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Section: Discussionsupporting

confidence: 91%

Association Between Hospitalization for Heart Failure and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes: An Observational Study

Johnston

Ghannam

et al. 2016

Diabetes Care

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“…Although metformin is known as the most confident hypoglycemic medicine in patients with CKD according to the benefits linked with reduction of metabolic disorder and protection against cardiovascular disease, present recommendations explain that it should be administrated with carefulness in GFR of lower than 60 mL/min (30). Other studies suggested an important clinical benefit for diabetes mellitus outcomes particularly MI from metformin compared with other oral agents like sulfonylurea agents.…”

Section: Discussionmentioning

confidence: 99%

Metformin protects renal tubular cells; mechanisms and new concepts

Dorestan¹,

Manzouri²,

Bahadoram³

et al. 2018

J Nephropathol

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Context:The prevalence of diabetes markedly increased in recent decades. It is well accepted that the risk of morbidity and fatality increases in patients with type 2 diabetes (T2DM). Evidence Acquisition: An electronic search was performed to detect suitable studies, with keywords of metformin, prediabetes, diabetes Mellitus, Gentamicin and lactic acidosis. Results: Metformin (biguanide) is widely used as the first pharmacological option in pre-diabetic subjects and patients with T2DM. Low-cost, long-term effect, low risk of hypoglycemia, and ease in utilization are considered as significant benefits of metformin compared with other therapies. Numerous studies have explored that medicinal intervention particularly metformin administration not only can decrease high blood glucose in patients with T2DM but also can avoid or postpone the beginning of clinical T2DM in pre-diabetic cases. Protective effect of metformin on renal cells by different mechanisms is described here. Gentamicin is an important factor that affects kidney function and structure. Nephrotoxicity is one of the serious side effects of gentamicin (an aminoglycoside antibiotic). Numerous investigation showed the protective effect of metformin against the gentamicin nephrotoxicity. On the other hand, lactic acidosis is known as an uncommon but serious side effect of metformin that should be mentioned. Signs of lactic acidosis are defined by plasma lactate levels higher than 5 mmol/L and pH smaller than 7.4. Conclusions: Different small series and large experimental investigations have discovered the association between metformin and lactic acidosis summarized here. ABSTRACT Implication for health policy/practice/research/medical education:Although metformin is known as the most confident hypoglycemic medicine in patients with chronic kidney disease according to the benefits linked with reduction of metabolic disorder and protection against cardiovascular disease, present recommendations explain that it should be administrated with carefulness in glomerular filtration rate of lower than 60 mL/ min. Other studies suggested an important clinical benefit for diabetes mellitus outcomes particularly myocardial infarction from metformin compared with other oral agents like sulfonylurea agents. Finally, elderly people may be at higher risk for lactic acidosis.

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“…Metformin is one of the first-line agents prescribed worldwide for the treatment of type 2 diabetes (1,8), based on its inhibition of insulin-dependent hepatic gluconeogenesis, promotion of glucose uptake into surrounding cells by improvement of insulin resistance and reduction of free fatty acids by inhibition of lipolysis (9)(10)(11). Metformin additionally inhibits the development of macroangiopathy to a greater extent than sulfonylureas do, which may be utilized for the treatment of type 2 diabetes (12). Metformin enhances glucose consumption in the intestine and produces lactic acid, which is used in hepatic gluconeogenesis (13).…”

Section: Metformin In the Treatment Of Type 2 Diabetesmentioning

confidence: 99%

Metformin: A candidate for the treatment of gynecological tumors based on drug repositioning

et al. 2016

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Abstract. Metformin is a first-line drug used for the treatment of type 2 diabetes. Recently, metformin has been reported to reduce the carcinogenic risk and inhibit tumor cell growth in glioma and breast cancer. The anticancer action of metformin involves the enhancement of phosphorylation of liver kinase B1, activation of adenosine monophosphate-activated protein kinase and inhibition of mammalian target of rapamycin, which reduces cell growth. Metformin is anticipated to exert antitumor effects in gynecological cancer, and its efficacy for the treatment of endometrial, breast and ovarian cancer has been suggested in preclinical studies and clinical trials. Although the effect of metformin on cervical cancer remains to be examined in clinical trials, its antitumor effects have been reported in preclinical studies. Thus, the use of metformin for the treatment of gynecological cancer may become a successful example of drug repositioning, following establishment of the drug's antitumor effects, risk evaluation, screening and validation of efficacy.

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Association between first‐line monotherapy with sulphonylurea versus metformin and risk of all‐cause mortality and cardiovascular events: a retrospective, observational study

Cited by 65 publications

References 24 publications

Association Between Hospitalization for Heart Failure and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes: An Observational Study

Association Between Hospitalization for Heart Failure and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes: An Observational Study

Metformin protects renal tubular cells; mechanisms and new concepts

Metformin: A candidate for the treatment of gynecological tumors based on drug repositioning

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