Among people with type 2 diabetes, using metformin could help prevent total joint replacement, a population-based cohort study showed.
Among more than 40,000 patients, daily metformin was associated with a 30% lower risk of total knee and total hip replacement compared with no metformin (adjusted HR 0.70, 95% CI 0.60–0.81) over a median follow-up of 54 months, Changhai Ding reported. , MD, PhD, of Southern Medical University in Guangzhou, China, and colleagues.
Broken down, metformin use was associated with lower risks for both total knee replacement (aHR 0.71, 95% CI 0.61-0.84) and total hip replacement (aHR 0, 61, 95% CI 0.41-0.92), they noted in the Canadian Medical Association. magazine
“We found that the use of metformin in patients with type 2 diabetes mellitus was associated with a significantly reduced risk of joint replacement, suggesting a potential therapeutic effect of metformin in patients with OA. [osteoarthritis]”, the researchers wrote. “Randomized controlled clinical trials are warranted to determine whether metformin is effective in patients with OA.”
The incidence of hip or knee replacement was 4.99 per 10,000 person-months for non-users versus 3.40 per 10,000 person-months for metformin patients.
The researchers also calculated whether or not this relationship was dose-dependent by separating the models for patients taking less than 1 g of metformin per day versus 1 + g per day, but found these results to be “inconsistent.”
“Metformin may decrease the risk of total joint replacement among patients with diabetes mellitus by multiple mechanisms, including reducing inflammation, maintaining adenosine 5′-monophosphate-activated protein kinase activity in the chondrocytes and the regulation of metabolism,” they explained.
Ding and team also noted that “metformin has been studied in patients without diabetes mellitus and [it] it was found to be safe.”
“Trials of metformin for the prevention of diabetes mellitus and for weight reduction among obese and non-diabetic patients showed that doses of 1.7-2.5 g/d could be prescribed without increase in the incidence of hypoglycemia or lactic acidosis,” they wrote.
The Taiwan-based study used data from 40,694 patients included in the National Health Insurance Research Database, evenly divided between those taking metformin and those not. The average age was 63 years and 49.8% were women. We excluded people with type 1 diabetes, as well as people under 45 years of age at the time of diabetes diagnosis.
Metformin exposure was defined as use within 180 days of or before a new diagnosis of type 2 diabetes from January 2000 to December 2012.
About 16% of the cohort had osteoarthritis at baseline. Some of the more common comorbidities include hypertension, hyperlipidemia, depression, and chronic obstructive pulmonary disease. Less than 1% of the cohort was obese.
More than half of metformin patients were taking a sulfonylurea, while only 7% of those not taking metformin were taking one. Metformin patients were also more likely to be taking insulin, α-glucosidase inhibitors, thiazolidinediones, or DPP-4 inhibitors.
Models were adjusted for baseline covariates including sex, age, urbanization, insurance type, severity of diabetes complications, comorbidities, pain control medications, other oral antihyperglycemic agents and the use of insulin.
-
Kristen Monaco is a staff writer, focusing on endocrinology, psychiatry and nephrology news. Based in the New York City office, he has been with the company since 2015.
disclosures
The study was supported by the National Natural Science Foundation of China, the Guangzhou Science and Technology Program, the Guangdong Basic and Applied Research Foundation, and the Wu Jieping Medical Foundation Program.
Ding reported no disclosures. Co-author Hunter reported relationships with Merck Serono, TLC Bio, Tissuegene, Lilly, and Pfizer. No other disclosures reported.
primary source
Journal of the Canadian Medical Association
Reference Source: Zhu Z, et al “Metformin use and associated risk of total joint replacement in patients with type 2 diabetes: a population-based comparative cohort study” CMAJ 2022; DOI: 10.1503/cmaj.220952.