Metformin effectively controls blood sugar in diabetics With moderate CKD: Study

USA: Blood sugar control is essential to delay or prevent the onset of diabetic kidney disease. There are a number of glucose-lowering medications available but only a fraction of them can be used safely in chronic kidney disease and many of them need an adjustment of dosage for the same.

Researchers have found in a new study that Metformin monotherapy was effective in lowering HbA1c regardless of stage 3 CKD status and, therefore, is a good option for initial blood sugar management therapy in this group of patients. Although people with type 2 diabetes and stage 3 chronic kidney disease (CKD3) are at increased risk of failure of metformin monotherapy.

The study has been published in the journal Diabetes, Obesity & Metabolism.

The researchers further added that the blood sugar lowering efficacy of metformin was the same in both the patients with and without CKD3. This means that metformin is a valuable treatment option for newly treated people with T2D and CKD3.

Consensus is growing that metformin is safe in patients with type 2 diabetes (T2D) and mild to moderate chronic kidney disease (CKD), metformin is no longer contraindicated in patients with stage 3 CKD (ie, estimated glomerular filtration rate 30–59 mL/min/1.73 m2).

Elvira O. Gosmanova, Department of Medicine, Stratton VA Medical Centre, Albany, New York, USA, and colleagues aimed to evaluate the glycaemic efficacy of metformin in people with type 2 diabetes and stage 3 chronic kidney disease.

For this purpose, the researchers conducted a retrospective study including 145980 US veterans with T2D and an estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2 who initiated metformin monotherapy between November 1999 and July 2017.

Propensity-score-matched cohorts were generated based on baseline variables associated with CKD3 (eGFR 30-59 mL/min/1.73 m2) to evaluate the independent association between CKD3 and metformin discontinuation, the addition of a second hypoglycaemic agent, and changes in glycated haemoglobin (HbA1c) from baseline in those with and without CKD3. 

"The study showed that the presence of CKD3 was associated with increased rates of metformin monotherapy discontinuation as well as a higher risk of failure to adequately control diabetes compared with non-CKD patients with T2D. On the other hand, the glycaemic efficacy of metformin in those CKD3 patients who remained on metformin monotherapy did not differ from non-CKD individuals," wrote the authors.

"These results suggest that metformin monotherapy initiation to improve glycaemic control in CKD3 is feasible; however, these patients may require closer follow-up to monitor for metformin adherence, side effects, and therapeutic efficacy. There is a need for further prospective studies to confirm and understand reasons for the higher risk of metformin monotherapy failure in individuals with CKD3," they concluded.

Reference:

The study titled, "Efficacy of metformin monotherapy in US veterans with type 2 diabetes and preexisting chronic kidney disease stage 3," is published in the journal Diabetes, Obesity & Metabolism.

DOI: https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14414