PMID- 32377525
OWN - NLM
STAT- MEDLINE
DCOM- 20210216
LR  - 20220414
IS  - 2314-6753 (Electronic)
IS  - 2314-6745 (Print)
VI  - 2020
DP  - 2020
TI  - Metformin Treatment Is Associated with a Decreased Risk of Nonproliferative 
      Diabetic Retinopathy in Patients with Type 2 Diabetes Mellitus: A 
      Population-Based Cohort Study.
PG  - 9161039
LID - 10.1155/2020/9161039 [doi]
LID - 9161039
AB  - PURPOSE: To assess the relationship between metformin use and the severity of 
      diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) and to 
      investigate the effect of metformin dosage on reducing the incidence of DR. 
      METHODS: The study population included patients with newly diagnosed T2DM, who 
      were aged >/=20 years and prescribed with antidiabetic drug therapy lasting >/=90 
      days, as identified using the National Health Insurance Research Database between 
      2000 and 2012. We matched metformin users and nonusers by a propensity score. Cox 
      proportional hazard regression analyses were used to compute and compare the risk 
      of developing nonproliferative diabetic retinopathy (NPDR) in metformin users and 
      nonusers. RESULTS: Overall, 10,044 T2DM patients were enrolled. Metformin 
      treatment was associated with a lower risk of NPDR (aHR 0.76, 95% CI 0.68-0.87) 
      and sight-threatening diabetic retinopathy (STDR, aHR 0.29, 95% CI 0.19-0.45); 
      however, the reduction in risk was borderline significant for STDR progression 
      among NPDR patients (aHR 0.54, 95% CI 0.28-1.01). Combination therapy of 
      metformin and DPP-4i exhibited a stronger but inverse relationship with NPDR 
      development (aHR 0.32, 95% CI 0.25-0.41), especially at early (<3 months) stages 
      of metformin prescription. These inverse relationships were also evident at 
      different metformin doses and in adapted Diabetes Complications Severity Index 
      scores (aDCSI). Moreover, combination therapy of metformin with sulfonylureas was 
      associated with an increased risk of NPDR. CONCLUSION: Metformin treatment in 
      patients with T2DM was associated with a reduced risk of NPDR, and a potential 
      trend was found for a reduced STDR risk in patients who had previously been 
      diagnosed with NPDR. Combining metformin with DPP-4i seemingly had a 
      significantly beneficial effect against NPDR risk, particularly when aDCSI scores 
      were low, and when metformin was prescribed early after T2DM diagnosis. These 
      results may recommend metformin for early treatment of T2DM.
CI  - Copyright (c) 2020 Yu-Pei Fan et al.
FAU - Fan, Yu-Pei
AU  - Fan YP
AD  - Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
AD  - Department of Medical Education, MacKay Memorial Hospital, Taipei, Taiwan.
FAU - Wu, Chien-Tung
AU  - Wu CT
AUID- ORCID: 0000-0001-6739-9456
AD  - Institute of Traditional Medicine, School of Medicine, National Yang-Ming 
      University, Taipei, Taiwan.
AD  - Department of Chinese Medicine, Taipei City Hospital, Linsen Chinese Medicine 
      Branch, Taipei, Taiwan.
AD  - Taiwan Association for Traditional Chinese Medicine of Family, Taipei, Taiwan.
FAU - Lin, Jiun-Lu
AU  - Lin JL
AD  - Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay 
      Memorial Hospital, Taipei, Taiwan.
FAU - Hsiung, Chao A
AU  - Hsiung CA
AD  - Institute of Population Health Sciences, National Health Research Institutes, 
      Taiwan.
FAU - Liu, Hsiao Yu
AU  - Liu HY
AD  - Institute of Population Health Sciences, National Health Research Institutes, 
      Taiwan.
FAU - Lai, Jung-Nien
AU  - Lai JN
AUID- ORCID: 0000-0002-9548-4938
AD  - School of Chinese Medicine, College of Chinese Medicine, China Medical 
      University, Taichung, Taiwan.
AD  - Departments of Chinese Medicine, China Medical University Hospital, Taichung, 
      Taiwan.
FAU - Yang, Chen-Chang
AU  - Yang CC
AUID- ORCID: 0000-0003-1391-8323
AD  - Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
AD  - Institute of Environmental and Occupational Health Sciences, National Yang-Ming 
      University School of Medicine, Taipei, Taiwan.
AD  - Division of Clinical Toxicology and Occupational Medicine, Department of 
      Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
LA  - eng
PT  - Journal Article
DEP - 20200419
PL  - England
TA  - J Diabetes Res
JT  - Journal of diabetes research
JID - 101605237
RN  - 0 (Hypoglycemic Agents)
RN  - 9100L32L2N (Metformin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cohort Studies
MH  - Diabetes Mellitus, Type 2/*drug therapy
MH  - Diabetic Retinopathy/*diagnosis/epidemiology
MH  - Disease Progression
MH  - Female
MH  - Humans
MH  - Hypoglycemic Agents/*therapeutic use
MH  - Incidence
MH  - Male
MH  - Metformin/*therapeutic use
MH  - Middle Aged
PMC - PMC7189314
COIS- All authors state that they have no conflicts of interest.
EDAT- 2020/05/08 06:00
MHDA- 2021/02/17 06:00
PMCR- 2020/04/19
CRDT- 2020/05/08 06:00
PHST- 2020/01/31 00:00 [received]
PHST- 2020/03/18 00:00 [accepted]
PHST- 2020/05/08 06:00 [entrez]
PHST- 2020/05/08 06:00 [pubmed]
PHST- 2021/02/17 06:00 [medline]
PHST- 2020/04/19 00:00 [pmc-release]
AID - 10.1155/2020/9161039 [doi]
PST - epublish
SO  - J Diabetes Res. 2020 Apr 19;2020:9161039. doi: 10.1155/2020/9161039. eCollection 
      2020.