Petrov Jessica C, Desai Aakash A, Kochhar Gursimran S, Crosby Sheena K, Kinnucan Jami A, Picco Michael F, Hashash Jana G, Farraye Francis A
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.
Division of Gastroenterology, Hepatology and Nutrition, Allegheny Health Network, Pittsburgh, PA, USA.
Inflamm Bowel Dis. 2025 May 12;31(5):1237-1247. doi: 10.1093/ibd/izae147.
Metformin exerts anti-inflammatory properties through a positive effect on oxidative stress, gut barrier integrity, and the gut microbiota. Our aim was to evaluate the influence of metformin on inflammatory bowel disease (IBD) outcomes in patients with type 2 diabetes mellitus (T2DM).
We conducted a retrospective cohort study using the TriNetX database in patients with IBD and T2DM who initiated metformin vs oral hypoglycemics or insulin (control cohort) between August 31, 2002, and August 31, 2022. One-to-one propensity score matching was performed. Primary outcomes were need for intravenous (IV) steroid use or IBD-related surgery within 1, 2, and 3 years after metformin initiation.
Our cohorts included 1323 patients with ulcerative colitis (UC) (mean age 58.7 ± 12.2 years, 50.1% female, 77.3% White) and 1278 patients with Crohn's disease (CD) (mean age 56.3 ± 12.6 years, 58.2% female, 76.5% White). At 1 year, patients with UC and CD were less likely to require IV steroids (UC: adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.34-0.59; P < .01; CD: aOR, 0.67; 95% CI, 0.53-0.85; P < .01). The decreased need for IV steroids persisted in all metformin groups at 2 and 3 years. Patients with CD were at a lower risk for IBD-related surgery at year 1 (aOR, 0.5; 95% CI, 0.31-0.81; P < .01), and this finding persisted at 3 years (aOR, 0.62; 95% CI, 0.43-0.89; P < .01). Metformin did not affect risk for surgery in patients with UC.
Patients with IBD and T2DM on metformin had a decreased likelihood of worse IBD outcomes.
二甲双胍通过对氧化应激、肠道屏障完整性和肠道微生物群产生积极影响发挥抗炎特性。我们的目的是评估二甲双胍对2型糖尿病（T2DM）患者炎症性肠病（IBD）结局的影响。
我们使用TriNetX数据库对2002年8月31日至2022年8月31日期间开始使用二甲双胍与口服降糖药或胰岛素（对照组）的IBD和T2DM患者进行了一项回顾性队列研究。进行了一对一倾向评分匹配。主要结局是在开始使用二甲双胍后的1、2和3年内是否需要静脉注射（IV）类固醇或进行与IBD相关的手术。
我们的队列包括1323例溃疡性结肠炎（UC）患者（平均年龄58.7±12.2岁，50.1%为女性，77.3%为白人）和1278例克罗恩病（CD）患者（平均年龄56.3±12.6岁，58.2%为女性，76.5%为白人）。在1年时，UC和CD患者需要静脉注射类固醇的可能性较小（UC：调整后的优势比[aOR]，0.45；95%置信区间[CI]，0.34 - 0.59；P <.01；CD：aOR, 0.67；95% CI，0.53 - 0.85；P <.01）。在2年和3年时，所有二甲双胍组中静脉注射类固醇的需求持续下降。CD患者在第1年进行与IBD相关手术的风险较低（aOR，0.5；95% CI，0.31 - 0.81；P <.01），这一发现持续到3年（aOR，0.62；95% CI，0.43 - 0.89；P <.01）。二甲双胍对UC患者的手术风险没有影响。
使用二甲双胍的IBD和T2DM患者出现更差IBD结局的可能性降低。
