Association between continued metformin use during hospital admission and hospital-acquired complications

IF 3.2 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine Pub Date : 2024-05-31 DOI:10.1111/dme.15353

Barbara Depczynski, Abbish Kamalakkannan, Bence Siklosi, Sue Mei Lau

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Abstract

Aims

The safety of continuing metformin during a hospital admission has not been robustly demonstrated. We evaluated the association of continuing metformin in hospital with the risk for a hospital-acquired complication (HAC).

Methods

This is a retrospective observational study of patients admitted to a medical or surgical ward. We considered those with diabetes who continued metformin (DM/MET group), those who discontinued metformin upon admission (DM/MET-STOP), and those with diabetes not on metformin just prior to and during admission (DM/NoMET). We prepared propensity score-matched (PSM) control groups from admitted patients without diabetes. The likelihood of a HAC was determined using a Kaplan–Meier survival analysis. A Cox proportional hazards model was employed to calculate the hazard ratio, adjusted for covariates.

Results

Of the 4446 (14%) patients with diabetes, 3331 (10%) were prescribed metformin on admission, and it was continued in 2557 patients. HAC occurred in 5.5% of DM/MET group and 6.4% of the PSM control group. Continuation of metformin was associated with a lower likelihood of HAC, adjusted hazard ratio 0.85 (95% CI 0.69, 1.04), p = 0.117 compared to a PSM-matched control group without diabetes. The DM/NoMET and DM/MET-STOP groups had an increased risk for HAC, adjusted HR 1.77 (1.44, 2.18), p < 0.001 and 2.57 (2.10, 3.13), p < 0.001, as compared to their respective PSM control groups.

Conclusion

An individualized assessment to continue metformin during hospital admission was associated with a reduced likelihood of HAC, with the caveat that there was limited matching to non-diabetes controls. This finding warrants further exploration.

Abstract Image

查看原文本刊更多论文

入院期间继续服用二甲双胍与医院获得性并发症之间的关系。

目的：住院期间继续服用二甲双胍的安全性尚未得到有力证实。我们评估了住院期间继续服用二甲双胍与医院获得性并发症（HAC）风险之间的关系：这是一项针对内科或外科病房住院患者的回顾性观察研究。我们考虑了继续服用二甲双胍的糖尿病患者（DM/MET组）、入院时停用二甲双胍的患者（DM/MET-STOP组）以及入院前和入院期间未服用二甲双胍的糖尿病患者（DM/NoMET组）。我们从无糖尿病的入院患者中准备了倾向得分匹配（PSM）对照组。采用卡普兰-梅耶生存分析法确定发生 HAC 的可能性。采用考克斯比例危险模型计算经协变量调整后的危险比：在4446名（14%）糖尿病患者中，有3331名（10%）患者在入院时服用了二甲双胍，有2557名患者继续服用二甲双胍。在 DM/MET 组和 PSM 对照组中，分别有 5.5% 和 6.4% 的患者发生 HAC。与无糖尿病的 PSM 匹配对照组相比，继续服用二甲双胍可降低 HAC 发生的可能性，调整后危险比为 0.85 (95% CI 0.69, 1.04)，p = 0.117。DM/NoMET组和DM/MET-STOP组发生HAC的风险增加，调整后的危险比为1.77（1.44，2.18），P 结论：入院期间继续服用二甲双胍的个性化评估与降低 HAC 的可能性有关，但需要注意的是，与非糖尿病对照组的匹配程度有限。这一发现值得进一步探讨。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetic Medicine 医学-内分泌学与代谢

CiteScore

7.20

自引率

5.70%

发文量

229

审稿时长

3-6 weeks

期刊介绍： Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”