Treatment of type 2 diabetes and outcomes in patients with heart failure: a nested case-control study from the U.K. General Practice Research Database
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OBJECTIVE: Diabetes and heart failure commonly coexist, and prior studies have suggested better outcomes with metformin than other antidiabetic agents. We designed this study to determine whether this association reflects a beneficial effect of metformin or a harmful effect of other agents. RESEARCH DESIGN AND METHODS: We performed a case-control study nested within the U.K. General Practice Research Database cohort in which diagnoses were assigned by each patient's primary care physician. Case subjects were patients 35 years or older, newly diagnosed with both heart failure and diabetes after January 1988, and who died prior to October 2007. Control subjects were matched to case subjects based on age, sex, clinic site, calendar year, and duration of follow-up. Analyses were adjusted for comorbidities, A1C, renal function, and BMI. RESULTS: The duration of concurrent diabetes and heart failure was 2.8 years (SD 2.6) in our 1,633 case subjects and 1,633 control subjects (mean age 78 years, 53% male). Compared with patients who were not exposed to antidiabetic drugs, the current use of metformin monotherapy (adjusted odds ratio 0.65 [0.48-0.87]) or metformin with or without other agents (0.72 [0.59-0.90]) was associated with lower mortality; however, use of other antidiabetic drugs or insulin was not associated with all-cause mortality. Conversely, the use of ACE inhibitors/angiotensin receptor blockers (0.55 [0.45-0.68]) and beta-blockers (0.76 [0.61-0.95]) were associated with reduced mortality. CONCLUSIONS: Our results confirm the benefits of trial-proven anti-failure therapies in patients with diabetes and support the use of metformin-based strategies to lower glucose.
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Some observational data suggest an increased mortality risk with sulphonylureas compared with metformin.
“Some observational data suggest an increased mortality risk with sulphonylureas compared with metformin.179,182”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [179]
In observational studies in HF, insulin was associated with higher mortality rates than metformin.
“In observational studies in HF, insulin was associated with higher mortality rates than metformin.179”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [179]
In observational studies in HF, metformin is associated with lower mortality rates than sulphonylureas or insulin.
“In observational studies in HF, metformin is associated with lower mortality rates than sulphonylureas or insulin.179”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [179]
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- Authors
- MacDonald, M. R., Eurich, D. T., Majumdar, S. R., Lewsey, J. D., Bhagra, S., Jhund, P. S., Petrie, M. C., McMurray, J. J. V., Petrie, J. R., & McAlister, F. A.
- Affiliations
- Golden Jubilee National Hospital (GB)
- University of Alberta (CA)
- Department of Public Health and Health Policy, University of Glasgow, Glasgow, Scotland;
- Sunderland Royal Hospital (GB)
- British Heart Foundation (GB)
- Corresponding author
- McAlister, Finlay A.
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2010-06-01
- Volume
- 33
- Issue
- 6
- Pages
- 1213-1218
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC2875425
- OpenAlex
- W2146723462
- Cited by
- 149
- References
- 24
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 9 · 2021: 9 · 2020: 19 · 2019: 12 · 2018: 13 · 2017: 16 · 2016: 14 · 2015: 6 · 2014: 11 · 2013: 11 · 2012: 12
- FWCI
- 8.45
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, heart failure, metformin, antidiabetic drugs, insulin, all-cause mortality, ACE inhibitors, angiotensin receptor blockers, beta-blockers, comorbidities, mortality
- MeSH terms
- Adrenergic beta-Antagonists, Aged, Aged, 80 and over, Angiotensin-Converting Enzyme Inhibitors, Aspirin, Diabetes Mellitus, Type 2, Digoxin, Female, United Kingdom, Heart Failure, Humans, Hypoglycemic Agents, Male, Metformin, Case-Control Studies
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