Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Internal Medicine, Division of Endocrinology and Metabolism, National Taiwan University Hospital, Taipei, Taiwan.
Otolaryngol Head Neck Surg. 2023 Jun;168(6):1389-1400. doi: 10.1002/ohn.232. Epub 2023 Jan 27.
To compare the risk of hearing loss with regard to metformin exposure.
Retrospective cohort.
Taiwan's National Health Insurance database.
We enrolled 292,071 ever users and 18,200 never users of metformin with new-onset diabetes mellitus from 1999 to 2005 and followed them for hearing loss from January 1, 2006, to December 31, 2011. Hazard ratios (HRs) weighted by propensity score were estimated.
Hearing loss was newly diagnosed in 10,085 ever users and 1072 never users. Their respective incidence rates (per 100,000 person-years) were 738.09 and 1366.83. The HR comparing ever-to-never users was 0.534 (95% confidence interval [CI]: 0.501-0.569]. The HR (95% CI) for the first (<27.07 months), second (27.07-59.13 months), and third (>59.13 months) tertiles of cumulative duration of metformin therapy were 0.912 (0.852-0.975), 0.544 (0.508-0.582), and 0.275 (0.255-0.295), respectively; and were 0.900 (0.841-0.962), 0.531 (0.496-0.569), and 0.293 (0.273-0.315), respectively, for the first (<796.70 g), second (796.70-2020.15 g), and third (>2020.15 g) tertiles of cumulative dose. The magnitude of risk reduction became more remarkable in corresponding to the increasing tertiles of the defined daily dose prescribed. Subtype analyses suggested that the risk reduction was more significant for sensorineural than conductive hearing loss. Findings derived from a propensity score-matched cohort did not substantially change the conclusions, and the risk reduction for mixed hearing loss was not statistically significant in the matched cohort as significantly observed in the unmatched cohort.
The risk of hearing loss is reduced in a dose-response pattern in patients who use metformin.
比较二甲双胍暴露与听力损失风险的关系。
回顾性队列研究。
台湾全民健康保险数据库。
我们纳入了 1999 年至 2005 年间新诊断为糖尿病且使用二甲双胍的 292071 例既往使用者和 18200 例从未使用者，并从 2006 年 1 月 1 日至 2011 年 12 月 31 日随访他们的听力损失情况。通过倾向评分加权估计风险比（HR）。
在既往使用者中，有 10085 例和从未使用者中，有 1072 例新诊断为听力损失。他们的发生率（每 10 万人年）分别为 738.09 和 1366.83。既往使用者与从未使用者相比，HR 为 0.534（95%置信区间[CI]：0.501-0.569）。累积二甲双胍治疗时间第 1（<27.07 个月）、第 2（27.07-59.13 个月）和第 3（>59.13 个月）三分位的 HR（95%CI）分别为 0.912（0.852-0.975）、0.544（0.508-0.582）和 0.275（0.255-0.295）；累积剂量第 1（<796.70 g）、第 2（796.70-2020.15 g）和第 3（>2020.15 g）三分位的 HR（95%CI）分别为 0.900（0.841-0.962）、0.531（0.496-0.569）和 0.293（0.273-0.315）。处方定义日剂量递增的三分位时，风险降低的幅度变得更加显著。亚组分析表明，对于感音神经性听力损失，风险降低更为显著。来自倾向评分匹配队列的研究结果没有实质性改变结论，并且在匹配队列中，混合性听力损失的风险降低在统计学上并不显著，而在未匹配队列中则显著观察到。
二甲双胍使用者的听力损失风险呈剂量反应模式降低。
