Department of Ophthalmology, Henry Ford Health System, 1 Ford Place 5D, Detroit, MI 48202, USA.
J Diabetes Res. 2018 Apr 30;2018:2801450. doi: 10.1155/2018/2801450. eCollection 2018.
To evaluate effects of long-term metformin on the severity of diabetic retinopathy (DR) in high-risk type 2 diabetic (T2D) patients.
A retrospective chart review study was conducted involving 335 DR patients with T2D ≥ 15 years from 1990 to 2013. The severity of DR was determined by Early Treatment Diabetic Retinopathy Study scale. The associations between metformin and DR severity were evaluated. Comparison with stratification for the use of sulfonylurea and insulin was performed to identify possible confounding effects.
Severe nonproliferative diabetic retinopathy or proliferative diabetic retinopathy (SNPDR/PDR) was more often diagnosed in nonmetformin users (67/142, 47%) versus metformin users (48/193, 25%) ( < 0.001), regardless of gender and race of the patients. The odds ratio of metformin associated with SNPDR/PDR was 0.37 in all cases ( < 0.001), 0.35 in sulfonylurea use cohort ( < 0.05), 0.45 in nonsulfonylurea use cohorts ( < 0.01), and 0.42 in insulin use cohort ( < 0.01). Insulin users had a higher rate of SNPDR/PDR. Metformin had no influence on the occurrence of clinical significant diabetic macular edema.
Long-term use of metformin is independently associated with a significant lower rate of SNPDR/PDR in patients with type 2 diabetes ≥ 15 years.
评估长期使用二甲双胍对高危 2 型糖尿病（T2D）患者糖尿病视网膜病变（DR）严重程度的影响。
进行了一项回顾性图表审查研究，纳入了 1990 年至 2013 年期间 335 名 T2D 病程≥15 年的 DR 患者。DR 的严重程度通过早期糖尿病视网膜病变研究量表确定。评估了二甲双胍与 DR 严重程度之间的关联。并进行了磺酰脲类药物和胰岛素使用的分层比较，以确定可能的混杂影响。
与二甲双胍使用者（48/193，25%）相比，非二甲双胍使用者（67/142，47%）更常被诊断为严重非增殖性糖尿病视网膜病变或增殖性糖尿病视网膜病变（SNPDR/PDR）（<0.001），无论患者的性别和种族如何。二甲双胍与 SNPDR/PDR 相关的比值比在所有病例中为 0.37（<0.001），在磺酰脲类药物使用队列中为 0.35（<0.05），在非磺酰脲类药物使用队列中为 0.45（<0.01），在胰岛素使用队列中为 0.42（<0.01）。胰岛素使用者 SNPDR/PDR 发生率更高。二甲双胍对临床显著糖尿病黄斑水肿的发生没有影响。
长期使用二甲双胍与 2 型糖尿病病程≥15 年的患者 SNPDR/PDR 发生率显著降低独立相关。
