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Effects of Metformin Exposure on Survival in a Large National Cohort of Patients With Diabetes and Cirrhosis

Kaplan, David E., Serper, Marina, John, Binu V., Tessiatore, Kristen M., Lerer, Renata, Mehta, Rajni, Fox, Rena, Aytaman, Ayse, Baytarian, Michelle, Hunt, Kristel, Albrecht, Jeffrey, Taddei, Tamar H.·2021·Clinical Gastroenterology and Hepatology
DOI 10.1016/j.cgh.2020.08.026
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Abstract

Background & aims Type II diabetes mellitus worsens the prognosis of cirrhosis. Multiple medications including metformin and statins often are co-administered to manage patients with diabetes. The aim of this study was to assess the impact of metformin exposure on mortality, hepatic decompensation, and hepatocellular carcinoma in individuals with diabetes and cirrhosis, controlling for multiple concomitant exposures. Methods We performed a retrospective cohort study of patients with cirrhosis diagnosed between January 1, 2008, through June 30, 2016, in the Veterans Health administration. Marginal structural models and propensity-matching approaches were implemented to quantify the treatment effect of metformin in patients with pre-existing diabetes with or without prior metformin exposure. Results Among 74,984 patients with cirrhosis, diabetes mellitus was present before the diagnosis of cirrhosis in 53.8%, and was diagnosed during follow-up evaluation in 4.8%. Before the diagnosis of cirrhosis, 11,114 patients had active utilization of metformin. In these patients, metformin, statin, and angiotensinogen-converting enzyme inhibitor/angiotensin-2-receptor blocker exposure were associated independently with reduced mortality (metformin hazard ratio, 0.68; 95% CI, 0.61-0.75); metformin was not associated with reduced hepatocellular carcinoma or hepatic decompensation after adjustment for concomitant statin exposure. For patients with diabetes before a diagnosis of cirrhosis but…

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Metadata

Authors
Kaplan, D. E., Serper, M., John, B. V., Tessiatore, K. M., Lerer, R., Mehta, R., Fox, R., Aytaman, A., Baytarian, M., Hunt, K., Albrecht, J., & Taddei, T. H.
ORCID
Kaplan, David E.
Venue
Clinical Gastroenterology and Hepatology
Publisher
Elsevier BV
Published
2021-10
Volume
19
Issue
10
Pages
2148-2160.e14
ISSN
1542-3565
DOI
10.1016/j.cgh.2020.08.026
Cited by
41
References
3
Language
en
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