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Kidney Week

Abstract: PO0757

Advantages of Metformin for the Prevention and Mitigation of Diabetic Foot Ulcer in Diabetic Kidney Disease from a Large-Scale, Real-World Cohort

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Kwon, Soie, Seoul National University Hospital Department of Internal Medicine, Jongno-gu, Seoul, Korea (the Republic of)
  • Kim, Dong Ki, Seoul National University Hospital Department of Internal Medicine, Jongno-gu, Korea (the Republic of)
  • Lim, Chun Soo, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Dongjak-gu, Korea (the Republic of)
  • Lee, Jung Pyo, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Dongjak-gu, Korea (the Republic of)
Background

Diabetic foot ulcer(DFU) and diabetic kidney disease (DKD) are diabetes-related microvascular complications strongly correlated with high morbidity and mortality. Metformin potentially confers a wound-healing advantage, although there are no well-established evidence. We first time investigated the effect of metformin on DFU among large retrospective cohort of DKD.

Methods

This retrospective cohort study enrolled DKD patients from two South Korean tertiary-referral centers. Primary outcomes were all-cause mortality and DFU events; secondary outcomes included hospitalization, amputation, composite of amputation or vascular intervention, and Wagner Grade >3. Multivariate cox analysis and Propensity score matching (PSM) was used to balance baseline intergroup differences between metformin users and metformin non-users.

Results

Among 10,832 patients (4,748 metformin users; 6,084 metformin non-users), the 117.5±66.9 months follow-up period, all-cause mortality rate and DFU incidence were, 37.1%, and 5.2%, respectively. Fully adjusted multivariate Cox analysis showed that metformin users had a lower all-cause mortality (adjusted hazard ratio 0.63; 95% confidence interval 0.58–0.68; p<0.001) and DFU events (0.39; 0.31–0.8; p<0.001, Table). After PSM, metformin users showed lower all-cause mortality (0.61; 0.55–0.67; p<0.001), DFU events (0.42; 0.32 –0.56; p<0.001), and secondary outcomes (hospitalization, amputation, composite of amputation or vascular intervention, and DFU with Wagner Grade >3. Table).

Conclusion

Metformin therapy in DKD patient can lower all-cause mortality, DFU incidence, and DFU progression.

Survival analysis of primary and secondary outcomes
 All-cause mortalityDiabetic foot ulcerHospitalizationAmputationComposite (Amputation & Vascular)Wagner Gr 3≤
 HR95% CIp valueHR95% CIp valueHR95% CIp valueHR95% CIp valueHR95% CIp valueHR95% CIp value
Model 10.4130.3863-0.4418<0.0010.377 0.3134-0.4528<0.0010.3187 0.2558-0.4549<0.0010.3411 0.2558-0.4549<0.0010.3713 0.2927-0.4712<0.0010.3545 0.2736-0.4592<0.001
Model 20.4580.4277-0.4901<0.0010.432
0.3585-0.5217
<0.0010.3816
0.3197-0.5781
<0.0010.4299 0.3197-0.5781<0.0010.4363 0.3418-0.5569<0.0010.4459
0.3417-0.5819<0.001
Model 30.5360.4983-0.5765<0.0010.467 0.3812-0.5710<0.0010.4116 0.3505-0.6689<0.0010.4842 0.3505-0.6689<0.0010.5131 0.3945-0.6673<0.0010.5169 0.3877-0.6891<0.001
Model 40.6260.5781-0.6778<0.0010.387 0.3114-0.4820<0.0010.3488 0.2826-0.5658<0.0010.39990.2826-0.5658<0.0010.4316 0.3254-0.5726<0.0010.4306 0.3158-0.5872<0.001
Model 50.6110.5537-0.6748<0.0010.420 0.3167-0.5560<0.0010.4058 0.2998-0.7001<0.0010.4581 0.2998-0.70010.00030.4849 0.3410-0.6895<0.0010.4823 0.3285-0.7081<0.001