Division of Rheumatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Front Endocrinol (Lausanne). 2021 Apr 23;12:641635. doi: 10.3389/fendo.2021.641635. eCollection 2021.
Metformin has been linked to anti-proliferative and anti-inflammatory mechanisms. In this study, we aimed to examine the long-term impact of metformin on mortality and organ damage in patients with autoimmune diseases and type 2 diabetes mellitus (T2DM).
We conducted a cohort study using the National Health Insurance Research Database in Taiwan between 1997 and 2013. Based on metformin and other anti-diabetic agent prescriptions, we categorized all patients with autoimmune diseases into either the metformin group (metformin administration for at least 28 days) or the non-metformin group. The primary outcomes were all-cause mortality and annual admission rate, while the secondary outcome was target organ damage. We followed patients from the index date to the date on which the event of interest occurred, death, or the end of this study.
Our cohort study included 3,359 subjects for analysis. During a mean follow up of 5.2 ± 3.8 years, the event rate of all-cause mortality was 228 (33.6%) in the metformin group and 125 (36.9%) in the non-metformin group. The risk of both all-cause mortality and annual number of admissions for autoimmune diseases was significantly lower in the metformin group than in the non-metformin group [hazard ratio (HR) 0.77; 95% CI 0.62-0.96 and risk ratio (RR) 0.81; 95% CI 0.73-0.90, respectively].
Metformin may add benefits beyond T2DM control with regard to reducing all-cause mortality and admission rate, as well as minimizing end-organ injury in lungs and kidneys among patients with autoimmune diseases.
二甲双胍与抗增殖和抗炎机制有关。本研究旨在探讨二甲双胍对自身免疫性疾病和 2 型糖尿病（T2DM）患者死亡率和器官损伤的长期影响。
我们在台湾进行了一项 1997 年至 2013 年的全国健康保险研究数据库队列研究。根据二甲双胍和其他抗糖尿病药物的处方，我们将所有自身免疫性疾病患者分为二甲双胍组（至少服用 28 天二甲双胍）或非二甲双胍组。主要结局是全因死亡率和年入院率，次要结局是靶器官损伤。我们从索引日期开始随访患者，直至发生感兴趣的事件、死亡或本研究结束。
我们的队列研究包括 3359 名患者进行分析。在平均 5.2±3.8 年的随访中，二甲双胍组的全因死亡率为 228 例（33.6%），非二甲双胍组为 125 例（36.9%）。二甲双胍组的全因死亡率和自身免疫性疾病年入院率均显著低于非二甲双胍组[风险比（HR）0.77；95%可信区间（CI）0.62-0.96 和风险比（RR）0.81；95%CI 0.73-0.90]。
二甲双胍除了控制 T2DM 之外，还可能通过降低全因死亡率和入院率，以及最大限度地减少肺部和肾脏等靶器官损伤，为自身免疫性疾病患者带来益处。
