StemCell Therapy

Takeaway

Metformin use was associated with an early reduction in haemoglobin (Hb) and increased rates of moderate anaemia in patients with type 2 diabetes (T2D), and this finding was consistent across two randomised controlled trials (RCTs) and replicated in one real-world study of routinely collected data.

Why this matters

Because the mechanisms for metformin-related moderate anaemia are unknown, the effects are modest, and the benefits of metformin are proven, the authors do not advocate avoidance or discontinuation even in patients with anaemia, but a reduction in Hb in the first few years after initiation might be anticipated.

Study design

Association between metformin use and anaemia risk in T2Dand the time course for thiswere evaluated in the A Diabetes Outcome Progression Trial (ADOPT; n=3967) and UK Prospective Diabetes Study (UKPDS; n=1473) RCTs.

The cumulative effect was evaluated in the observational Genetics of Diabetes Audit and Research in Tayside Scotland (GoDARTS) population (n=3485).

Funding: Medical Research Council.

Key results

In ADOPT, compared with sulphonylureas, the OR for anaemia was 1.93 (95% CI, 1.10-3.38) for metformin and 4.18 (95% CI, 2.50-7.00) for thiazolidinediones (TZDs).

In UKPDS, compared with diet, the OR for anaemia was 3.40 (95% CI, 1.98-5.83) for metformin, 0.96 (95% CI, 0.57-1.62) for sulphonylureasand 1.08 (95% CI, 0.62-1.87) for insulin.

In ADOPT, Hb and haematocrit levels dropped by 6 months in both metformin and TZDs groups with no further Hb decrease between 3 and 5 years.

In UKPDS, Hb levels dropped by 3 years with metformin treatment vs other treatments.

At 6 and 9 years, Hb levels were reduced in all treatment groups with no greater further fall seen in the metformin vs diet-treated group (0.49 g/dL [95% CI, -1.64 to 2.62] vs 0.50 g/dL [95% CI, -1.71 to 2.72] fall from 3 to 9 years).

In GoDARTS, each 1 g/day of metformin use was associated with a 2% increased annual risk of anaemia.

Limitations

Donnelly LA, Dennis JM, Coleman RL, Sattar N, Hattersley AT, Holman RR, Pearson ER. Risk of Anemia With Metformin Use in Type 2 Diabetes: A MASTERMIND Study. Diabetes Care. 2020 Aug 14 [Epub ahead of print]. doi: 10.2337/dc20-1104. PMID: 32801130. View abstract.

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.

Cite this: Metformin Use Linkedto Early Risk of Anaemia in Type 2 Diabetes-Medscape-Aug19,2020.

The rest is here:
Metformin Use Linked to Early Risk of Anaemia in Type 2 Diabetes - Medscape

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