Effect of metformin-containing antidiabetic regimens on all-cause mortality in veterans with type 2 diabetes mellitus

Elvira O. Gosmanova, Robert B. Canada, Therese A. Mangold, William N. Rawls, Barry Wall

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective: There are conflicting reports concerning metformin use and mortality rates in patients with type 2 diabetes (T2DM). The aim of this study was to examine the relationship between metformin use and all-cause mortality in veterans with T2DM. Research Design and Methods: An observational cohort study involving 2206 patients with T2DM was performed using computerized database from the Veterans Affairs Medical Center, Memphis, TN. All-cause mortality was compared among cohorts of metformin and nonmetformin users. Univariate and multivariate Cox regression models were used to estimate hazard ratios (HR) for all-cause mortality after adjusting for age, race, baseline estimated glomerular filtration rate, glycosylated hemoglobin, use of insulin, use of ACE inhibitors or angiotensin II receptor blockers or statins. Results: The average length of follow-up in metformin and nonmetformin users was 62 ± 17 and 61 ± 18 months, respectively. The mean age was 63 ± 11 years. Crude mortality rates were similar in both groups: 266 (22%) metformin users and 253 (25.3%) nonmetformin users died. There was a trend for improved survival with metformin use (unadjusted HR 0.85, P = 0.07). After multivariate adjustment, metformin users had significantly decreased HR for time to all-cause mortality compared with nonmetformin users (adjusted HR 0.77, P < 0.01). Insulin use was an independent predictor of worsened survival in both univariate and multivariate analyses. In subgroup analysis of patients exposed to insulin, all-cause mortality remained decreased in metformin users (adjusted HR 0.62, P < 0.04). Conclusion: Treatment of T2DM with regimens containing metformin alone or in combination with other hypoglycemic agents was associated with reduced all-cause mortality compared with regimens without metformin.

Original languageEnglish (US)
Pages (from-to)241-247
Number of pages7
JournalAmerican Journal of the Medical Sciences
Volume336
Issue number3
DOIs
StatePublished - Jan 1 2008

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Metformin
Veterans
Hypoglycemic Agents
Type 2 Diabetes Mellitus
Mortality
Insulin
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Survival
Angiotensin Receptor Antagonists
Glycosylated Hemoglobin A
Glomerular Filtration Rate
Proportional Hazards Models
Angiotensin-Converting Enzyme Inhibitors
Observational Studies
Cohort Studies
Research Design
Multivariate Analysis
Databases

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Effect of metformin-containing antidiabetic regimens on all-cause mortality in veterans with type 2 diabetes mellitus. / Gosmanova, Elvira O.; Canada, Robert B.; Mangold, Therese A.; Rawls, William N.; Wall, Barry.

In: American Journal of the Medical Sciences, Vol. 336, No. 3, 01.01.2008, p. 241-247.

Research output: Contribution to journalArticle

Gosmanova, Elvira O. ; Canada, Robert B. ; Mangold, Therese A. ; Rawls, William N. ; Wall, Barry. / Effect of metformin-containing antidiabetic regimens on all-cause mortality in veterans with type 2 diabetes mellitus. In: American Journal of the Medical Sciences. 2008 ; Vol. 336, No. 3. pp. 241-247.
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