Trending Clinical Topic: Metformin

Ryan Syrek

Disclosures

August 28, 2020

Each week, we identify one top search term, speculate about what caused its popularity, and provide an infographic on a related condition. If you have thoughts about what's trending and why, share them with us on Twitter or Facebook. Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Curiosity about a potential role in COVID-19, along with studies exploring other benefits and adverse effects, made metformin this week's top trending clinical topic.

The most commonly prescribed drug for type 2 diabetes (T2D) may be associated with reduced risk for death due to COVID-19. The latest results, which are not yet peer reviewed, were recently published online and show a significant reduction in mortality in patients with diabetes and COVID-19 who used metformin (see Infographic below). These findings support the results of four previous studies that also showed a reduction in mortality among metformin users compared with nonusers. However, experts say that the randomized controlled trials needed to conclusively prove this benefit are "almost impossible in the context of COVID-19."

Other possible benefits of metformin have been explored recently. A retrospective observational study of more than 5000 patients with T2D, published earlier this spring, found that older adults who received preoperative metformin had higher 90-day survival rates and fewer readmissions than those who were not taking the drug. A separate, small retrospective study found that metformin may also help improve motor function in individuals with diabetes and Parkinson's disease. Also earlier this year, an observational study from South Korea found that metformin was associated with a reduced risk for death and end-stage renal disease among people with T2D who have chronic kidney disease.

The news hasn't been all positive, however. Research out of the United Kingdom found that metformin use was associated with increased rates of moderate anemia in patients with T2D. This finding was consistent across two randomized controlled trials and replicated in one real-world study of routinely collected data. In one of the studies, each 1 g/day of metformin use was associated with a 2% increased annual risk for anemia.

In considering metformin's role overall in those with diabetes, the largest network meta-analysis of diabetes drugs to date indirectly compared 21 glucose-lowering drugs for adults with T2D in nine drug classes and 453 trials. The findings suggest that for drug-naive patients at low cardiovascular risk, the use of metformin as a first-line therapy for diabetes seems justified. The optimal initial treatment for drug-naive patients at increased cardiovascular risk remains unclear.

As more investigations continue to clarify metformin's role in T2D and related conditions, the drug is likely to remain a top trending clinical topic.

Read more about the treatment of T2D.

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