title: Effect of metformin-containing antidiabetic regimens on all-cause mortality in veterans with type 2 diabetes mellitus.
abstract: OBJECTIVE
  There are conflicting reports concerning metformin use and mortality rates in patients with type 2 diabetes (T2DM). The aim of this study was to examine the relationship between metformin use and all-cause mortality in veterans with T2DM.
  
  
  METHODS
  An observational cohort study involving 2206 patients with T2DM was performed using computerized database from the Veterans Affairs Medical Center, Memphis, TN. All-cause mortality was compared among cohorts of metformin and nonmetformin users. Univariate and multivariate Cox regression models were used to estimate hazard ratios (HR) for all-cause mortality after adjusting for age, race, baseline estimated glomerular filtration rate, glycosylated hemoglobin, use of insulin, use of ACE inhibitors or angiotensin II receptor blockers or statins.
  
  
  RESULTS
  The average length of follow-up in metformin and nonmetformin users was 62 +/- 17 and 61 +/- 18 months, respectively. The mean age was 63 +/- 11 years. Crude mortality rates were similar in both groups: 266 (22%) metformin users and 253 (25.3%) nonmetformin users died. There was a trend for improved survival with metformin use (unadjusted HR 0.85, P = 0.07). After multivariate adjustment, metformin users had significantly decreased HR for time to all-cause mortality compared with nonmetformin users (adjusted HR 0.77, P < 0.01). Insulin use was an independent predictor of worsened survival in both univariate and multivariate analyses. In subgroup analysis of patients exposed to insulin, all-cause mortality remained decreased in metformin users (adjusted HR 0.62, P < 0.04).
  
  
  CONCLUSIONS
  Treatment of T2DM with regimens containing metformin alone or in combination with other hypoglycemic agents was associated with reduced all-cause mortality compared with regimens without metformin.
authors.affiliation: Veterans Affairs Medical Center, Memphis, Tennessee, USA.
authors.forename: Elvira O
authors.initials: EO
authors.lastname: Gosmanova
authors.forename: Robert B
authors.initials: RB
authors.lastname: Canada
authors.forename: Therese A
authors.initials: TA
authors.lastname: Mangold
authors.forename: William N
authors.initials: WN
authors.lastname: Rawls
authors.forename: Barry M
authors.initials: BM
authors.lastname: Wall
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000401:mortality*; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D016016:Proportional Hazards Models; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D013714:Tennessee; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin; D013453:Sulfonylurea Compounds