College of Public Health, University of Iowa, Iowa City, IA, USA.
Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Respirology. 2019 Jul;24(7):646-651. doi: 10.1111/resp.13486. Epub 2019 Feb 13.
Chronic lower respiratory diseases (CLRD) increase the risk of type 2 diabetes, which in turn may worsen lung function. Metformin, a common antidiabetic with anti-inflammatory and antioxidant properties, may improve respiratory outcomes. Therefore, we examined the association of metformin use with the risk of mortality from CLRD.
We analysed data from the National Health and Nutrition Examination Survey during 1988-1994 and 1999-2010 for participants aged 40 years or older who had diabetes and were followed up for mortality through 2011. Information on prescription medicine was collected at baseline and CLRD-related mortality during follow-up was defined using the 10th Revision of the International Classification of Diseases (ICD-10). Cox proportional hazards modelling was used to determine the mortality hazard ratio (HR) associated with metformin use, adjusting for relevant covariates.
A total of 5266 participants with a median follow-up of 6.1 years were included. The prevalence of metformin use was 31.9% and 1869 participants died during follow-up, including 72 of CLRD. In the adjusted Cox proportional regression analysis, metformin was associated with a decreased risk of CLRD mortality in the overall population (HR: 0.39, 95% CI: 0.15-0.99) and among participants with baseline CLRD (HR: 0.30, 95% CI: 0.10-0.93), after adjusting for age, gender, race/ethnicity, cigarette smoking, body mass index, current asthma and chronic obstructive pulmonary disease (COPD), insulin and other diabetic medications, and glycohaemoglobin level. We found no association between other antidiabetic medications and CLRD mortality.
In this sample representative of the U.S. population, metformin was associated with lower CLRD mortality in adults with diabetes.
慢性下呼吸道疾病（CLRD）会增加 2 型糖尿病的风险，而后者又可能使肺功能恶化。二甲双胍是一种常用的降糖药，具有抗炎和抗氧化作用，可能改善呼吸结局。因此，我们研究了二甲双胍的使用与 CLRD 相关死亡率的关系。
我们分析了 1988-1994 年和 1999-2010 年全国健康与营养调查的数据，纳入年龄 40 岁及以上、患有糖尿病且随访至 2011 年死亡的参与者。基线时收集了处方药信息，随访期间根据国际疾病分类第 10 次修订版（ICD-10）定义了与 CLRD 相关的死亡率。采用 Cox 比例风险模型确定与二甲双胍使用相关的死亡率风险比（HR），并对相关协变量进行调整。
共纳入 5266 名中位随访时间为 6.1 年的参与者。二甲双胍的使用率为 31.9%，随访期间共有 1869 名参与者死亡，其中 72 人死于 CLRD。在调整后的 Cox 比例回归分析中，二甲双胍与全人群 CLRD 死亡率降低相关（HR：0.39，95%CI：0.15-0.99），与基线时患有 CLRD 的参与者相关（HR：0.30，95%CI：0.10-0.93），调整了年龄、性别、种族/民族、吸烟状况、体质指数、当前哮喘和慢性阻塞性肺疾病（COPD）、胰岛素和其他糖尿病药物以及糖化血红蛋白水平。我们未发现其他降糖药与 CLRD 死亡率之间存在关联。
在这个代表美国人群的样本中，二甲双胍与糖尿病成人 CLRD 死亡率降低相关。
