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Metformin: Benefits in Insulin Using Patients?

Association between Insulin Monotherapy versus Insulin plus Metformin and the Risk of All-Cause Mortality and Other Serious Outcomes: A Retrospective Cohort Study

Holden SE, et al. PLoS ONE 2016_11(5): e0153594

What were the findings (excerpted form the Abstract)?

The purpose of this study was to determine if concomitant metformin reduced the risk of death, major adverse cardiac events (MACE), and cancer in people with type 2 diabetes treated with insulin. The study was a retrospective cohort study, people with type 2 diabetes who progressed to insulin with or without metformin from 2000 onwards were identified from the UK Clinical Practice Research Datalink (~7% sample of the UK population). The risks of all-cause mortality, MACE and incident cancer were evaluated using multivariable Cox models comparing insulin monotherapy with insulin plus metformin taking into account the dose of insulin.

The study population was 12,020 subjects treated with insulin, including 6,484 treated with insulin monotherapy. There were 1,486 deaths, 579 MACE (excluding those with a history of large vessel disease), and 680 cancer events (excluding those in patients with a history of cancer). For patients who were propensity-score matched, the corresponding adjusted Hazard Ratios (aHRs) for all-cause mortality and cancer were 0.62 and 0.99, respectively. The authors concluded that people with type 2 diabetes treated with insulin plus concomitant metformin had a reduced risk of death and MACE compared with people treated with insulin monotherapy. There was no statistically significant difference in the risk of cancer between people treated with insulin as monotherapy or in combination with metformin.