Metformin Significantly Reduces Risk of Renal Function Deterioration in Type 2 Diabetes: Study

The study was a retrospective observational study among 316,693 multicenter cohorts with type 2 diabetes across seven hospitals. Propensity score matching was performed to calibrate age, gender, medical year, baseline estimated glomerular filtration rate, urine protein by dipstick, and glycated hemoglobin for creating a balanced comparison. Finally, 13,096 metformin users were compared to 13,096 non-metformin users. The adverse key endpoints measured included a doubling of serum creatinine, eGFR ≤ 15 mL/min/1.73 m², and ESKD.

Results

The metformin group demonstrated significantly better renal outcomes than the non-metformin group:

• Doubling of Serum Creatinine: Metformin users had a lower incidence (HR 0.71; 95% CI 0.65-0.77).

• eGFR ≤ 15 mL/min/1.73 m²: The risk was significantly reduced (HR 0.61; 95% CI 0.53-0.71).

• End-Stage Kidney Disease (ESKD): Metformin users had a reduced risk (HR 0.55; 95% CI 0.47-0.66).

Subgroup Analyses

• The renoprotective effect of metformin was consistent across a wide array considering the radically wide variations in patient subgroups in terms of age, sex, comorbidities, and medications used concomitantly.

• The metformin group witnessed slower deterioration in renal function in nearly all subgroups than the non-metformin group.

The study stresses further that, as compared to other antihyperglycemic agents, metformin might be useful in the management of renal function in patients with T2D. Prior to this, there had been a lot of controversies hovering around the findings, but these results support very strongly metformin's role in slowing down progression in DKD. This meta-analysis connected metformin use with a significantly reduced rate for the incidence of severe renal outcomes, especially with regard to doubling in serum creatinine and in those patients with extremely low levels of eGFR/ESKD.

The results clearly emerge that, in patients with T2D, clinicians should not consider metformin for glycemic control alone but also for renoprotection. The study suggested that metformin may be one of the effective tools in delaying the progression of DKD, improving overall patient outcomes.

Metformin significantly lowers the risk of decline in renal function among subjects with T2DM. This current study thus supports metformin therapy in T2DM patients in reducing DKD progression and hence adds more support to administration beyond simple glucose control.

Reference:

Wang, H.-H., Lin, S.-H., Hung, S.-Y., Chiou, Y.-Y., Hsu, W.-C., Chang, C.-M., Liou, H.-H., Chang, M.-Y., Ho, L.-C., Wu, C.-F., & Lee, Y.-C. (2024). Renal protective effect of metformin in type 2 diabetes patients. The Journal of Clinical Endocrinology and Metabolism, dgae477. https://doi.org/10.1210/clinem/dgae477