Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran.
Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Physiology, Faculty of Medicine, Iran University of Medical Science, Tehran, Iran.
Diabetes Metab Syndr. 2023 Feb;17(2):102721. doi: 10.1016/j.dsx.2023.102721. Epub 2023 Feb 1.
Stroke and cardiovascular diseases are major causes of death and disability, especially among diabetic patients. Some studies have shown that metformin has been effective in preventing cardiovascular diseases. In this study, we aim to evaluate the effect of metformin on stroke in type 2 diabetic patients.
A comprehensive search was conducted in Medline, Embase, Scopus, and Web of Science databases from their inception till 1st July 2022. Randomized clinical trials (RCT) and cohort studies were included. Two independent researchers screened the records, extracted the data, and assessed the risk of bias and certainty of evidence. Findings were reported as risk ratio (RR) and 95% confidence interval (CI). All statistical analyses were performed using the STATA 17.0 software package.
Analysis of 21 included studies with 1,392,809 patients demonstrated that metformin monotherapy was effective in reducing stroke risk in both RCTs (RR = 0.66, 95% CI: 0.50, 0.87 p = 0.004) and cohort studies (RR = 0.67, 95% CI: 0.55, 0.81, p < 0.0001). However, combined administration of metformin with other antihyperglycemic agents had no significant effect on stroke risk reduction in either the RCTs (RR = 0.92, 95% CI: 0.69, 1.22 p = 0.558) or the cohort studies (RR = 0.79, 95% CI: 0.59, 1.06, p = 0.122).
Low to moderate level of evidence in RCTs showed that metformin monotherapy could reduce stroke risk in type 2 diabetic patients. However, the preventive effect of metformin in stroke was not observed in patients who received a combination of metformin plus other hypoglycemic agents.
中风和心血管疾病是死亡和残疾的主要原因，尤其是在糖尿病患者中。一些研究表明，二甲双胍在预防心血管疾病方面是有效的。在本研究中，我们旨在评估二甲双胍对 2 型糖尿病患者中风的影响。
从数据库建立到 2022 年 7 月 1 日，我们在 Medline、Embase、Scopus 和 Web of Science 数据库中进行了全面检索。纳入随机临床试验（RCT）和队列研究。两名独立的研究人员筛选记录、提取数据，并评估了偏倚风险和证据确定性。结果以风险比（RR）和 95%置信区间（CI）报告。所有统计分析均使用 STATA 17.0 软件包进行。
对 21 项纳入研究（共 1392809 例患者）的分析表明，二甲双胍单药治疗在 RCT 中（RR=0.66，95%CI：0.50，0.87，p=0.004）和队列研究中（RR=0.67，95%CI：0.55，0.81，p<0.0001）均有效降低中风风险。然而，在 RCT 中（RR=0.92，95%CI：0.69，1.22，p=0.558）和队列研究中（RR=0.79，95%CI：0.59，1.06，p=0.122），二甲双胍与其他抗高血糖药物联合使用对降低中风风险没有显著影响。
RCT 中的低到中等证据水平表明，二甲双胍单药治疗可降低 2 型糖尿病患者的中风风险。然而，在接受二甲双胍联合其他降糖药物治疗的患者中，未观察到二甲双胍在中风中的预防作用。
