Metformin use and associated risk of total joint replacement in patients with type 2 diabetes: a population-based matched cohort study.
Metformin use and associated risk of total joint replacement in patients with type 2 diabetes: a population-based matched cohort study.
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DOI：
10.1503/cmaj.220952
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发表时间：
2022-12-19
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目前还不确定二甲双胍的使用是否与2型糖尿病患者关节置换术的风险降低有关。我们的目的是确定二甲双胍的使用是否与这些患者的全膝关节置换术（TKR）或全髋关节置换术（THR）的风险降低有关。我们选择了2000年至2012年期间从台湾全民健康保险研究数据库中诊断的2型糖尿病患者。我们使用处方时间分布匹配和倾向评分匹配来平衡二甲双胍使用者和非使用者之间的潜在混杂因素。我们使用考克斯比例风险回归评估了TKR或THR的风险。我们纳入了20347名未接受二甲双胍治疗的参与者和20347名接受二甲双胍治疗的参与者，在处方时间分布匹配后，共纳入40694名参与者（平均年龄63岁，标准差11岁; 49.8%为女性）。与未使用二甲双胍的受试者相比，使用二甲双胍的受试者的TKR或THR风险较低（TKR或THR的校正风险比[HR] 0.70，95%置信区间[CI] 0.60-0.81; TKR的校正HR 0.71，95% CI 0.61-0.84;校正协变量后，THR的校正HR 0.61，95% CI 0.41-0.92）。倾向评分匹配分析（10163例未接受二甲双胍治疗的受试者与10163例接受二甲双胍治疗的受试者）和使用治疗加权逆概率和竞争风险回归的敏感性分析显示了相似的结果。2型糖尿病患者使用二甲双胍可显著降低全关节置换术的风险。在骨关节炎患者中进行随机对照临床试验，以确定二甲双胍是否能有效减少关节置换的需要。
It is uncertain whether metformin use is associated with reduced risk of joint replacement in patients with type 2 diabetes mellitus. We aimed to establish whether metformin use was associated with a reduced risk of total knee replacement (TKR) or total hip replacement (THR) among these patients. We selected patients with type 2 diabetes mellitus that was diagnosed between 2000 and 2012 from the Taiwan National Health Insurance Research Database. We used prescription time-distribution matching and propensity-score matching to balance potential confounders between metformin users and nonusers. We assessed the risks of TKR or THR using Cox proportional hazards regression. We included 20 347 participants who were not treated with metformin and 20 347 who were treated with metformin, for a total of 40 694 participants (mean age 63 yr, standard deviation 11 yr; 49.8% were women) after prescription time-distribution matching. Compared with participants who did not use metformin, those who used metformin had lower risks of TKR or THR (adjusted hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.60–0.81 for TKR or THR; adjusted HR 0.71, 95% CI 0.61–0.84 for TKR; adjusted HR 0.61, 95% CI 0.41–0.92 for THR) after adjustment for covariates. Propensity-score matching analyses (10 163 participants not treated with metformin v. 10 163 treated with metformin) and sensitivity analyses using inverse probability of treatment weighting and competing risk regression showed similar results. Metformin use in patients with type 2 diabetes mellitus was associated with a significantly reduced risk of total joint replacement. Randomized controlled clinical trials in patients with osteoarthritis are warranted to determine whether metformin is effective in decreasing the need for joint replacement.
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影响因子：
158.5
作者：
Knowler, WC;Barrett-Connor, E;Nathan, DM
通讯作者：
Nathan, DM
影响因子：
5.3
作者：
Kurtz, Steven M.;Ong, Kevin L.;Bozic, Kevin J.
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Bozic, Kevin J.
影响因子：
5.5
作者：
Li, Delong;Ruan, Guangfeng;Ding, Changhai
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Ding, Changhai
影响因子：
4.4
作者：
Park, Min-Jung;Moon, Su-Jin;Cho, Mi-La
通讯作者：
Cho, Mi-La
影响因子：
20.1
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Cameron AR;Morrison VL;Levin D;Mohan M;Forteath C;Beall C;McNeilly AD;Balfour DJ;Savinko T;Wong AK;Viollet B;Sakamoto K;Fagerholm SC;Foretz M;Lang CC;Rena G
通讯作者：
Rena G