Conference Paper Abstract/Meeting Abstract ()
Al Zadjali M, Ogston SA, Evans J, Morris AD, Struthers AD & Lang CC (2008) Clinical outcomes of metformin in patients with heart failure and type 2 diabetes (Meeting Abstract).
Recent problemsrelatedtothe use of thiazolidinediones highlight the difficulties in managing diabetes in patients with congestive heart failure (CHF).An alternative and cheaper approach is to use the insulin sensitizer,metformin.This study aimed to evaluate the safety of metformin and to explore any evidence of benefit of its use in CHF in a large population prescription database study.
The Health Informatics Centre (HIC) dispensed prescribing database for the population of Tayside,Scotland (400,000 people) was employed. Subjects with incident CHF (n = 774) between 1994-2003 were identified through administrative medical records based on ICD-9 code 428, ICD-10 code-50. Subjects were grouped according to oral hypoglycaemic agents into three study cohorts: metformin monotherapy (n = 90), sulfonylurea monotherapy (n = 381) and combination (n = 303). Cox regression model was used to assess differences in all-cause mortality, all-cause hospitalization and combination of all-cause hospitalization or mortality by estimation of relative risks.
Average age of subjects was 74 years, 55% were male; subjects were followed for 10 years. All cause mortality rates were lower among patients treated with metformin alone (60.0%) compared with those treated with sulfonylurea monotherapy (77.4%, P < 0.0001). For 1 year mortality there were fewer deaths with metformin and the combination group than with sulfonylurea monotherapy. After adjusting for confounding factors and propensity score, the adjusted risk ratio for metformin was 0.45 (95% CI 0.23, 0.89, P < 0.05) and 0.66 (95% CI 0.46, 0.96, P < 0.05) for combination group.
Patients in the metformin group had lower risk of hospitalization, with an adjusted risk ratio of 0.74 (95% CI 0.57, 0.96,P < 0.05). Combined end points (all-cause hospitalization or mortality) were lower in the metformin group compared with sulfonylurea monotherapy, 0.74 (95% CI 0.56, 0.99, P < 0.05).
In this large observational study of CHF patients treated with oral hypoglycaemic agents, those treated with metformin alone or in combination were associated with a markedly lower risk of morbidity and mortality when compared with those receiving sulfonylurea alone.
|Authors||Al Zadjali Matlooba, Ogston Simon A, Evans Josie, Morris Andrew D, Struthers Allan D, Lang Chim C|
British Journal of Clinical Pharmacology: Volume 65, Issue 6 (JUN 2008)