Metformin and thiazolidinedione combo most effective for preventing AF in type 2 diabetes

A new study published in Diabetes Research and Clinical Practice suggests that Metformin (MET) and thiazolidinedione (TZD) was most effective anti-diabetic medication combination for preventing AF in patients with type 2 diabetes.

Despite the notion that diabetes increases the likelihood of developing atrial fibrillation (AF), research on how anti-diabetic medications affect AF risk is sparse. The purpose of this study, which was carried out by Sunyoung Kim and colleagues, was to assess how anti-diabetic medications affected the incidence of AF in Korean patients with type 2 diabetes.

This study included 2,515,468 people with type 2 diabetes from the Korean National Insurance Service database who had health examinations between 2009 and 2012 and had no prior history of AF. According to the primary anti-diabetic medication combinations used in the actual world up until December 2018, an incidence of newly diagnosed AF was observed.

The key findings of this study were;

1. 89,125 patients (mean age, 62 11 years; 60% men) have just received an AF diagnosis.

2. Metformin (MET) combination treatment (HR 1) and MET alone (HR 0.959, 95% CI 0.935-0.985) both markedly reduced the probability of AF in comparison to the non-medication group.

3. Even after controlling for a number of variables, MET (HR 0.977, 95% CI 0.964-0.99)

and thiazolidinedione (TZD; HR 0.926, 95% CI 0.898-0.956) were the two anti-diabetic medications that consistently shown a protective effect against the occurrence of AF.

4. Additionally, compared to other medication combinations, this protective effect was more notable with MET and TZD combination treatment (HR 0.802, 95% CI 0.754-0.853).

5. Regardless of age, sex, length, or the severity of the diabetes, the preventative impact of MET and TZD therapy against AF was constant in the subgroup analysis.

The findings of this study clearly state the efficacy of combined therapy of MET and TZD as an antidiabetic drug against type 2 diabetes.

Reference: 

Kim, S., Park, S. Y., Kim, B., Min, C., Cho, W., Yon, D. K., Kim, J. Y., Han, K.-D., Rhee, E.-J., Lee, W.-Y., & Rhee, S. Y. (2023). Association between antidiabetic drugs and the incidence of atrial fibrillation in patients with type 2 diabetes: A nationwide cohort study in South Korea. In Diabetes Research and Clinical Practice (Vol. 198, p. 110626). Elsevier BV. https://doi.org/10.1016/j.diabres.2023.110626