1451-P: The Association of Metformin with Mortality in Frail Older Veterans with Diabetes

Abstract

Diabetes (DM) is associated with an accelerated aging that promotes frailty, a state of vulnerability to stressors resulting in higher morbidity, mortality and healthcare utilization. Data from the UKPDS showed that metformin may lead to lower risk of overall mortality in middle aged adults with type 2 DM (T2D) but the evidence is less clear in frail older adults. The aim of this study was to determine whether metformin is associated with reduced mortality in frail older Veterans. This is a retrospective cohort study of 393 Veterans 65 years and older with DM, who were identified as frail through calculation of a 44-item frailty index (FI≥.21) on January 2016-August 2017 and followed until October 2018. The FI was constructed as a proportion of all potential variables (demographics, comorbidities, medications, laboratory tests, and ADLs) at the time of the screening. At the end of follow-up, we aggregated data on mortality of those Veterans with frailty and compared those who were taking metformin (n=164, 41.7%) versus those who were not taking that medication (n=229, 58.3%). After adjusting for age, race, ethnicity, BMI, DM complications, level of glycemic control, use of insulin or sulfonylureas and comorbidities, the association of metformin with mortality was determined using a multivariate Cox regression model. Patients were 56.3% white, 76.9% non-Hispanic, 98.7% male, mean age was 73.14 (SD=7.31) years. Over a median follow-up period of 593 days (IQR=179), 62 deaths occurred (n=15, in those taking metformin vs. n=47 in those not taking it). After adjusting for covariates, frail Veterans taking metformin had a lower risk for mortality, adjusted hazard ratio (HR) .466 (95% CI: .255-.849), p=.013 than those not taking the drug. These results suggest that metformin may reduce all-cause mortality in frail older adults with diabetes. Further studies may be needed to assess the impact of metformin on quality of life and potential benefits on specific morbidity and mortality in this high-risk population. Disclosure R. Milyani: None. R. Aparicio-Ugarriza: None. J. Ferri Guerra: None. D. Salguero: None. Y. Mohammed: None. W. Valencia: None. H. Florez: None. J.G. Ruiz: None. Funding Miami VA Healthcare System Geriatric Research Education and Clinical Center