March 28, 2023

Mr. Reid Whitlock, a Statistician in the Chronic Diseases Innovation Center at Seven Oaks General Hospital in Winnipeg, Manitoba, Canada, reviews results of his study appearing in the January 2020 issue of Mayo Clinic Proceedings. He found that Metformin was safe to use in patients with type 2 diabetes and chronic kidney disease and that this offers patients earlier benefit from metformin’s cardiovascular protection. Available at:

Vanya real model therapy is associated with a higher risk for office mortality cardiovascular events and major hypoglycemic episodes compared with metformin and that meant foreman may be a safer alternative to salt on ureas even in patients with chronic kidney disease hi i’m reed whitlock and i’m a statistician of the chronic disease innovation center at seven oaks

Hospital in winnipeg manitoba and i’m the lead author of the article titled safety comparison of metformin versus salvatierra initiation in patients with type 2 diabetes and chronic kidney disease a retrospective cohort study which will appear in the january 2020 issue of mayo clinic proceedings so it’s well established on metformin is the most common treatment

That individuals with type 2 diabetes initiate to the letter blood sugar but for those with chronic kidney disease guidelines often caution against metformin because of slower kidney clearance and a perceived increased risk of lactic acidosis which although rare cannot be fatal in place of metformin so flawed areas are likely to be the most common alternative for

Mono therapy so we evaluated whether the risk for all cause mortality cardiovascular events or major hypoglycemic episodes differed in individuals who are newly prescribed metformin versus often areaa as first-line model therapies and whether the presence or absence of chronic kidney disease modify these relationships we answered this question using population level

Administrative health databases for the province of manitoba canada through the manitoba center for health policy at the university of manitoba now our study had 22,000 people and overall after adjusting for age sex kidney function comorbidities and concomitant medications metformin monotherapy was associated with a lower risk of all-cause mortality cardiovascular

Events and major hypoglycemic episodes compared with saudi areas now if you look at the p-values of the interaction terms you can see that the mortality benefit of metformin did attenuate in individuals with chronic kidney disease but we found that chronic kidney disease did not modify the effect of metformin on cardiovascular events or the interactive glycemic

Episodes so even though there were differences in mortality risk depending on it an individual had chronic kidney disease the risks shifted in such a way that the mortality benefit of metformin was neutralized and not reversed and there were no differences in cardiovascular event risk or hypoglycemia no risk depending on your kidney function which means that the

Overall finding of a risk reduction benefit for metformin applies to those with and without provocated disease how this finding relates to clinical practice is that it adds to a body of evidence that the pharmaceutical labeling and association guidelines that clinicians follow when they make their clinical decisions should be re-examined at least for individuals

With an egfr between 30 and 60 or moderate chronic kidney disease and that clinicians should not necessarily feel uncomfortable starting a patient with type 2 diabetes and moderate chronic disease on metformin to the vasana arena and what this means for patients with type 2 diabetes and moderate chronic disease is that there is more evidence to suggest that they

Can safely initiate metformin and benefit from the cardiovascular risk reduction and not have to experience the potential harm assault on areas in terms of hypoglycemia or waking and the good news is that just like salt on areas that foreman is available to patients at a cost that is relatively inexpensive the next step in this line of research would be to look

At more real-world evidence on this topic in other parts of the world and as more observation time accumulates to look at data on how some of the newer diabetes drugs such as sglt2 inhibitors fare as model therapy in patients with type 2 diabetes and harmik immune disease in terms of safety events thank you we hope you found this presentation from the content

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Transcribed from video
Metformin vs Sulfonylurea in Patients With Type 2 Diabetes & CKD By Mayo Proceedings