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Abstract: FR-PO241

Metformin Discontinuation in Type 2 Diabetes Patients Associated with Higher Risk of Diabetic Nephropathy: Finding from a Retrospective, Propensity Score-Matched, Common Data Model-Based Cohort Study

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Yi, Yongjin, Seoul National University Bundang Hospital, Seongnam-si, GyeonGgi-Do, Korea (the Republic of)
  • Kim, Kipyo, Seoul National University Bundang Hospital, Seongnam-si, GyeonGgi-Do, Korea (the Republic of)
  • Jeong, Jong Cheol, Seoul National University Bundang Hospital, Seongnam-si, GyeonGgi-Do, Korea (the Republic of)
  • Chin, Ho Jun, Seoul National University Bundang Hospital, Seongnam-si, GyeonGgi-Do, Korea (the Republic of)
  • Na, Ki Young, Seoul National University Bundang Hospital, Seongnam-si, GyeonGgi-Do, Korea (the Republic of)
  • Chae, Dong-Wan, Seoul National University Bundang Hospital, Seongnam-si, GyeonGgi-Do, Korea (the Republic of)
  • Kim, Sejoong, Seoul National University Bundang Hospital, Seongnam-si, GyeonGgi-Do, Korea (the Republic of)
Background

Metformin is a first-line drug in patients with type 2 diabetes (T2DM) worldwide. There are several evidences supporting benefits to T2DM patients in cardiovascular and renal outcomes with metformin, however, a long-term use of metformin is occasionally limited owing to risk of lactic acidosis or gastrointestinal side effects. This common data model-based study aimed to compare continuous metformin user with non-metformin user for risk of diabetic nephropathy (DN) in a real-world setting.

Methods

We performed a retrospective, propensity score matched, observational cohort study by using The Observational Medical Outcomes Partnership common data model version 5 (OMOP-CDMv5). We used medical data of 1.82 million patients in a tertiary hospital in South Korea from 2003 to 2017. Study participants were identified by drugs, diagnosis codes and laboratory test values in combination with event time. Among newly diagnosed T2DM patients without DN, more than one year ongoing of metformin treatment were considered as treatment group. Never use of metformin after four months since time of T2DM diagnosis were considered as comparative group. DN defined as onset of spot urine albumin to creatinine ratio (uACR)>30 mg/g, protein to creatinine ratio (uPCR)>150 mg/g or EPI-CKD eGFR<60 ml/min/1.73m2. After 1:1 propensity score-based matching (PSM), the Cox proportional hazards model was used to analyze hazard ratio (HR) for DN events.

Results

A 2,003 of metformin using patients and a 222 of non-metformin using patients were identified. After 1:1 PSM, we matched each of 207 patients in both groups. Mean follow-up duration was 7.2 and 6.5 years, respectively. There were no significant differences of mean age, sex ratio, mean HbA1c, EPI-CKD eGFR, uACR and uPCR value between two groups at baseline. Metformin treatment group had lower risk for progression to DN (HR=0.66, 95% CI [0.47-0.93], p=0.018) than comparative group.

Conclusion

Continuous use of metformin in T2DM without DN was associated lower risk for progression of diabetic nephropathy. This longitudinal, real-world setting study may support protective effect of metformin for progression to diabetic nephropathy in T2DM.