Renal and Death Risks Lower with Metformin than Sulfonylureas
PHILADELPHIA—Initiating treatment of type 2 diabetes with sulfonylurea drugs is associated with an increased risk of renal function decline, end-stage renal disease (ESRD), or death compared with starting treatment on metformin, according to study findings presented at Kidney Week 2011.
Compared with patients who initiated diabetes treatment with metformin, those who started with sulfonylureas had an adjusted 20% increased risk of a primary outcome of a persistent decline in estimated glomerular filtration rate (eGFR) of 25% or more (eGFR event) or diagnosis of ESRD.
In addition, sulfonylurea use was associated with an adjusted 20% increased risk of a secondary outcome of an eGFR event, ESRD, or death compared with metformin use. The researchers, led by Adriana M. Hung, MD, MPH, a Veterans Affairs Career Development Awardee and Assistant Professor of Medicine at Vanderbilt University in Nashville, Tenn., observed no difference in risk between metformin and rosiglitazone with respect to either the primary or secondary outcome.
The study examined a retrospective cohort of 93,577 veterans (mean age 62 years, 78% white, and 96% male) with type 2 diabetes who filled their first prescription for an oral antidiabetic drug between October 1, 2001 and September 30, 2008, and had an eGFR of 60 mL/min/1.73 m2. The group included 61,104 patients who started on metformin, 30,550 who started on a sulfonylurea drug, and 1,923 who started on rosiglitazone.
“There are important renal benefits to using metformin compared to sulfonylurea,” Dr. Hung told Renal & Urology News. “This effect could potentially be related to the increasingly recognized anti-inflammatory and anti-oxidant effects of metformin.”
“The findings of this large study support the current recommendations of metformin as first-line therapy for patients with diabetes type 2,” Dr. Hung added. “More studies are needed to evaluate the benefits and potential risks of antidiabetic medications in patients with more advanced renal disease.”