TY - JOUR
T1 - Effect of metformin on microvascular outcomes in patients with type 2 diabetes
T2 - A systematic review and meta-analysis
AU - Gerardo González-González, José
AU - Cesar Solis, Ricardo
AU - Díaz González-Colmenero, Alejandro
AU - Raygoza-Cortez, Karina
AU - Moreno-Peña, Pablo J.
AU - Sánchez, Alicia L.
AU - McCoy, Rozalina G.
AU - Singh Ospina, Naykky
AU - Maraka, Spyridoula
AU - Brito, Juan P.
AU - Rodriguez-Gutierrez, René
N1 - Funding Information:
This effort was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) grant K23DK114497 (McCoy). Study contents are the sole responsibility of the authors and do not necessarily represent the official views of NIH. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Funding Information:
SM was supported by the Arkansas Biosciences Institute, the major research component of the Arkansas Tobacco Settlement Proceeds Act of 2000, and by the United States Department of Veterans Affairs Health Services Research & Development Service of the VA Office of Research and Development, under Merit review award number 1I21HX003268-01A1. The views expressed in the article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the United States Government. In the past 36 months, Dr. McCoy also received research support from the NIDDK (R03DK114497, P30DK111024) and AARP® Quality Measure Innovation Grant through funds paid to Mayo Clinic. NSO was supported by the National Cancer Institute of the National Institutes of Health under Award Number K08CA248972. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2022
PY - 2022/4
Y1 - 2022/4
N2 - Aims: Examine the efficacy of metformin compared to placebo or other glucose-lowering medications on microvascular outcomes in patients with Type 2 Diabetes Mellitus (T2DM). Methods: MEDLINE, EMBASE, Web of Science, and Scopus were searched from database inception to March 2020. We included randomized clinical trials of patients with T2DM receiving metformin compared with another active glucose-lowering treatment or placebo in which a microvascular outcome was assessed. The risk of bias was assessed using the Cochrane Risk of Bias tool. Microvascular complications included kidney-related outcomes, retinopathy, and peripheral neuropathy. An inverse-weighted variance random-effect meta-analysis was performed to estimate drugs effect over microvascular disease. PROSPERO (CRD42019120365). Results: Nineteen RCTs (n = 18,181) were included. Metformin increased estimated glomerular filtration rate (eGFR) by a mean difference (MD) of 1.08 (95% CI 0.84 to 1.33 ml/min/1.73 m2) after 24 weeks. No effect was found on urinary albumin-creatinine ratio, serum creatinine, and end-stage kidney disease; Patient-important outcomes regarding kidney disease, retinal outcomes, peripheral neuropathy or quality of life were not assessed by any of the included studies and could not be analyzed. Conclusions: There is no evidence of clinically significant beneficial effect of metformin therapy as compared to other glucose-lowering medications or placebo on the examined microvascular complications.
AB - Aims: Examine the efficacy of metformin compared to placebo or other glucose-lowering medications on microvascular outcomes in patients with Type 2 Diabetes Mellitus (T2DM). Methods: MEDLINE, EMBASE, Web of Science, and Scopus were searched from database inception to March 2020. We included randomized clinical trials of patients with T2DM receiving metformin compared with another active glucose-lowering treatment or placebo in which a microvascular outcome was assessed. The risk of bias was assessed using the Cochrane Risk of Bias tool. Microvascular complications included kidney-related outcomes, retinopathy, and peripheral neuropathy. An inverse-weighted variance random-effect meta-analysis was performed to estimate drugs effect over microvascular disease. PROSPERO (CRD42019120365). Results: Nineteen RCTs (n = 18,181) were included. Metformin increased estimated glomerular filtration rate (eGFR) by a mean difference (MD) of 1.08 (95% CI 0.84 to 1.33 ml/min/1.73 m2) after 24 weeks. No effect was found on urinary albumin-creatinine ratio, serum creatinine, and end-stage kidney disease; Patient-important outcomes regarding kidney disease, retinal outcomes, peripheral neuropathy or quality of life were not assessed by any of the included studies and could not be analyzed. Conclusions: There is no evidence of clinically significant beneficial effect of metformin therapy as compared to other glucose-lowering medications or placebo on the examined microvascular complications.
KW - Metformin
KW - Microvascular
KW - Patient important outcomes
KW - Systematic review
KW - Type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85126995214&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85126995214&partnerID=8YFLogxK
U2 - 10.1016/j.diabres.2022.109821
DO - 10.1016/j.diabres.2022.109821
M3 - Review article
C2 - 35247521
AN - SCOPUS:85126995214
VL - 186
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
SN - 0168-8227
M1 - 109821
ER -