Abstract
BackgroundMany factors influence whether the first-line oral anti-diabetic drug, metformin, should be initiated to a patient with type 2 diabetes mellitus (T2DM) early in the course of management in addition to lifestyle modifications. This study aims to evaluate the net effects of metformin monotherapy (MM) on the all-cause mortality and cardiovascular disease (CVD) events.MethodsA retrospective 5-year follow-up cohort study was conducted on Chinese adult patients with T2DM and without any CVD history under public primary care. Cox proportional hazard regressions were performed to compare the risk of all-cause mortality and CVD events (CHD, stroke, heart failure) between patients receiving lifestyle modifications plus MM (MM groups) and those with lifestyle modifications alone (control groups).Results3400 pairs of matched patients were compared. MM group had an incidence rate of 7.5 deaths and 11.3 CVD events per 1000 person-years during a median follow-up period of 62.5 months whereas control group had 11.1 deaths and 16.3 per 1000 person-years during a median follow-up period of 43.5–44.5 months. MM group showed a 29.5 and 30–35 % risk reduction of all-cause mortality and CVD events (except heart failure) than control group (P < 0.001). MM group was more prone to progress to chronic kidney disease but this was not statistically significant.ConclusionsType 2 diabetic patients who were started on metformin monotherapy showed improvement in many of the clinical parameters and a reduction in all-cause mortality and CVD events than lifestyle modifications alone. If there is no contraindication and if tolerated, diabetic patients should be prescribed with metformin early in the course of the diabetic management to minimize their risk of having the cardiovascular events and mortality in the long run.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-015-0304-2) contains supplementary material, which is available to authorized users.
Highlights
Many factors influence whether the first-line oral anti-diabetic drug, metformin, should be initiated to a patient with type 2 diabetes mellitus (T2DM) early in the course of management in addition to lifestyle modifications
Patients in metformin monotherapy (MM) group were defined as patients who were prescribed metformin as their sole anti-Diabetes mellitus (DM) drugs at baseline, and they were excluded if an additional anti-DM drug was added or if they switched to another class of oral antidiabetic (OAD) drug or insulin, or stopped metformin within 1 year after the baseline, while patients in control group were defined as patients not using any of the anti-DM drugs at baseline, and they were excluded if any anti-DM drug was added within 1 year after the baseline
This study showed that diabetic patients who were started with MM showed improvement in many of the clinical parameters including haemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoproteincholesterol (LDL-C), total cholesterol (TC)/high-density lipoprotein-cholesterol (HDL-C), and body mass index (BMI), and a reduction in allcause mortality and cardiovascular disease (CVD) events when compared to lifestyle changes alone
Summary
Many factors influence whether the first-line oral anti-diabetic drug, metformin, should be initiated to a patient with type 2 diabetes mellitus (T2DM) early in the course of management in addition to lifestyle modifications. Patients may prefer not to start OAD drugs for various reasons, including possible side-effects, compliance issues, life-long drug therapy etc. These concerns are not limited to the Chinese population, but are worldwide [6,7,8]. This study aims to evaluate the net effectiveness of MM on the diabetes-related cardiovascular complications and mortality in Chinese patients diagnosed with type 2 diabetes by comparing patients with lifestyle modifications alone and patients with lifestyle modifications plus MM
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