Kidney Week

Abstract: FR-PO245

A Safety Comparison of Metformin vs. Sulfonylurea Initiation in Patients with Type 2 Diabetes and CKD: A Retrospective Cohort Study

Session Information

• Diabetic Kidney Disease: Advancing Treatment
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Whitlock, Reid, Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada

Reid Whitlock,

• Hougen, Ingrid, University of Manitoba, Winnipeg, Manitoba, Canada

Ingrid Hougen,

• Komenda, Paul, Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada

Paul Komenda,

• Rigatto, Claudio, Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada

Claudio Rigatto,

• Clemens, Kristin, Western University, London, Ontario, Canada

Kristin Clemens,

• Tangri, Navdeep, Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada

Navdeep Tangri,

Background

Metformin is the initial oral antihyperglycemic agent of choice in most patients with type 2 diabetes (T2D). However, in patients with chronic kidney disease (CKD), guidelines often recommend that metformin not be used due to slower clearance and risk of lactic acidosis. Sulfonylureas are a common alternative to metformin but have been associated with hypoglycemia, weight gain and cardiovascular events. We sought to compare the safety of metformin versus sulfonylureas in patients with T2D by CKD stage.

Methods

This retrospective cohort study included adults in Manitoba, Canada with T2D, an incident monotherapy prescription for metformin or a sulfonylurea, and a serum creatinine measurement from April 2006 to March 2017. Patients were stratified by estimated glomerular filtration rate (eGFR) into the following groups: eGFR ≥90, 60-89, 45-59, 30-44 or <30 ml/min/1.73 m². Outcomes included all-cause mortality, cardiovascular events, and major hypoglycemic episodes. Baseline characteristics were used to calculate propensity scores and perform inverse probability of treatment weights analysis and eGFR group was examined as an effect modifier for each outcome.

Results

The cohort consisted of 21,996 individuals (19,990 metformin users and 2,006 sulfonylurea users). Metformin use was associated with a lower risk of all-cause mortality (HR 0.48, 95% CI 0.40-0.58, p<0.001), cardiovascular events (HR 0.67, 95% CI 0.52-0.86, p=0.002), and major hypoglycemic episodes (HR 0.14, 95% CI 0.09-0.20, p<0.001), when compared to sulfonylureas. CKD was a significant effect modifier for all-cause mortality (p=0.002), but not for cardiovascular events or major hypoglycemic episodes.

Conclusion

Sulfonylurea monotherapy is associated with a higher risk of all-cause mortality, major hypoglycemic episodes and cardiovascular events compared to metformin. Although the presence of CKD attenuated the mortality benefit, metformin may be a safer alternative to sulfonylureas in patients with CKD.

Funding

• Veterans Affairs Support –