Metformin, Diabetes and Death
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METFORMIN, DIABETES AND DEATH
Metformin is a diabetes medication that is of great interest to me, and to other cancer specialists, because of intriguing research data suggesting that it may reduce the risk of cancer occurrence and cancer recurrence in people with diabetes. (Diabetes is, itself, a risk factor for certain types of cancer, including one of the most lethal of all cancers, pancreatic cancer.)
Metformin has been shown to be particularly beneficial in reducing the risk of death due to the complications of diabetes in overweight and obese patients, who are especially prone to developing diabetes. However, there has been some concern regarding the potential safety of metformin in patients with preexisting cardiovascular disease and kidney disease, and so this first-line diabetes medication has not been extensively prescribed to diabetic patients with these diseases. (Somewhat ironically, cardiovascular disease and kidney disease are, themselves, known complications of diabetes.) For this reason, the clinical research study that I will be discussing in today’s column is especially important to the estimated 24 million patients in the United States, alone, who have diabetes, and to the hundreds of thousands of diabetic patients who have already developed cardiovascular disease and kidney disease in the US.
This newly published study, which appears in the current issue of the Archives of Internal Medicine, reports on the results of the massive Reduction of Atherothrombosis for Continued Health (REACH) Study, which included 19,691 patients with documented diabetes. (The researchers involved in the REACH Study have been following this huge number of patient volunteers since they enlisted in the study between December 2003 and December 2004.)
The findings of this very large prospective public health study validate the findings of smaller prior clinical studies. In this study, diabetic patients with cardiovascular disease were significantly less likely to die during the course of this study if they took metformin instead of other diabetes medications (or no diabetes medication at all). The patients in this study who took metformin were 24 percent less likely to die when compared to the diabetic patients who did not take metformin. Among patients with congestive heart failure, which has until recently has been considered a contraindication to taking metformin, the use of metformin was associated with a 31 percent reduction in death due to all causes. Moreover, patients with other health conditions that have previously thought to preclude diabetes treatment with metformin also appeared to benefit from metformin in this study. Diabetic patients with cardiovascular disease who were older than 65 years were 23 percent less likely to die if they took metformin, while patients with decreased kidney function (estimated creatinine clearance of 30 to 60 ml/minute) experienced a whopping 36 percent decrease in the risk of death if they took metformin.
As this was an observational study (i.e., there were no randomized groups of patients, and there was no placebo-control group), it should be urgently followed with a prospective, randomized, placebo-controlled clinical research study to confirm these highly important clinical findings. Taken together, however, the findings of this pivotal public health study are certain to eventually expand the number of patients with diabetes who will be considered eligible to receive metformin!
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Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity
Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author
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