Gallo Robert J, Lin Shoutzu, Fang Daniel Z, Glassman Peter A, Sahay Anju, Heidenreich Paul A
Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Rd (152-MPD), Menlo Park, CA, 94025, USA.
Department of Health Policy, Stanford University, Stanford, CA, USA.
J Gen Intern Med. 2025 Feb 3. doi: 10.1007/s11606-025-09384-y.
Metformin is the first-line treatment for diabetes, with multiple long-term benefits. However, there is limited evidence for its use in the inpatient setting, and clinical guidelines have historically recommended holding oral diabetes medications during acute hospitalization. While studies have not found evidence of harm from continuing metformin during hospitalization, withholding may lead to unnecessary insulin prescriptions, which in turn may lead to hypoglycemia events after discharge and other associated complications.
To investigate the association between metformin use during hospitalization and post-hospitalization outcomes.
Observational cohort study from January 2016 to January 2022, emulating a target trial.
Adults with type 2 diabetes admitted to a Veterans Health Administration hospital for common medical conditions.
Continuation of an outpatient metformin prescription during hospitalization.
Hypoglycemia within 90 days of discharge. Secondary outcomes included insulin prescriptions at discharge, 90-day readmissions, and 90-day mortality.
The propensity-matched cohort included 67,162 hospitalizations, equally split between those who did and did not have metformin continued during hospitalization. Within 90 days of hospital discharge, those that received metformin had lower risk of hypoglycemia (1.5% vs 1.8%; OR 0.83, 95% CI 0.73-0.93; p = 0.003), readmissions (29.4% vs 30.6%; OR 0.96, 95% CI 0.92-1.00; p= 0.03), and mortality (6.4% vs 7.4%; OR 0.86, 95% CI 0.80-0.92; p <0.001). Patients receiving metformin also had lower risk of insulin prescriptions at discharge (18.5% vs 20.3%; OR 0.89, 95% CI 0.84-0.95; p<0.001).
Continuation of metformin during hospitalization for patients with type 2 diabetes was associated with decreased risk of post-hospitalization insulin prescriptions and 90-day hypoglycemia, readmissions, and mortality. These findings question clinical guideline recommendations to hold metformin during hospitalization.
二甲双胍是糖尿病的一线治疗药物，具有多种长期益处。然而，其在住院患者中的使用证据有限，并且临床指南历来建议在急性住院期间停用口服降糖药。虽然研究未发现住院期间继续使用二甲双胍有危害的证据，但停药可能导致不必要的胰岛素处方，进而可能导致出院后低血糖事件及其他相关并发症。
研究住院期间使用二甲双胍与出院后结局之间的关联。
2016年1月至2022年1月的观察性队列研究，模拟目标试验。
因常见疾病入住退伍军人健康管理局医院的2型糖尿病成年患者。
住院期间继续门诊二甲双胍处方。
出院后90天内的低血糖情况。次要结局包括出院时的胰岛素处方、90天再入院率和90天死亡率。
倾向评分匹配队列包括67162例住院病例，住院期间继续使用二甲双胍和未继续使用二甲双胍的患者各占一半。出院后90天内，继续使用二甲双胍的患者发生低血糖的风险较低（1.5%对1.8%；OR 0.83，95%CI 0.73 - 0.93；p = 0.003）、再入院率较低（29.4%对30.6%；OR 0.96，95%CI 0.92 - 1.00；p = 0.03）以及死亡率较低（6.4%对7.4%；OR 0.86，95%CI 0.80 - 0.92；p <0.001）。继续使用二甲双胍的患者出院时开具胰岛素处方的风险也较低（18.5%对20.3%；OR 0.89，95%CI 0.84 - 0.95；p <0.001）。
2型糖尿病患者住院期间继续使用二甲双胍与出院后胰岛素处方风险降低以及90天内低血糖、再入院率和死亡率降低相关。这些发现对住院期间停用二甲双胍的临床指南建议提出了质疑。
