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Association of Metformin Use with Iron Deficiency Anemia in Urban Chinese Patients with Type 2 Diabetes

Background: Previous evidence yielded contradictory findings on the relationship between metformin and anemia. This study aims to assess whether metformin use is associated with iron-deficiency anemia (IDA) risk in patients with type 2 diabetes (T2D) in Beijing, China. Methods: Overall, 60,327 newly...

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Autores principales: Wu, Junhui, Yang, Ruotong, Yu, Huan, Qin, Xueying, Wu, Tao, Wu, Yiqun, Hu, Yonghua
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10385822/
https://www.ncbi.nlm.nih.gov/pubmed/37513498
http://dx.doi.org/10.3390/nu15143081
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author Wu, Junhui
Yang, Ruotong
Yu, Huan
Qin, Xueying
Wu, Tao
Wu, Yiqun
Hu, Yonghua
author_facet Wu, Junhui
Yang, Ruotong
Yu, Huan
Qin, Xueying
Wu, Tao
Wu, Yiqun
Hu, Yonghua
author_sort Wu, Junhui
collection PubMed
description Background: Previous evidence yielded contradictory findings on the relationship between metformin and anemia. This study aims to assess whether metformin use is associated with iron-deficiency anemia (IDA) risk in patients with type 2 diabetes (T2D) in Beijing, China. Methods: Overall, 60,327 newly diagnosed T2D patients were included based on a historical cohort study design. The information pertaining to these patients was gathered from the Beijing Medical Claim Data for Employees Database. These patients were then categorized into the metformin and non-metformin groups and matched on a 1:1 propensity score based on their initial antidiabetic prescription. The Cox proportional hazards models were utilized to calculate the incidences and the hazard ratios (HRs). Results: The study enrolled 27,960 patients with type 2 diabetes, with 13,980 patients in each of the initial glucose-lowering prescription groups: metformin and non-metformin. During a median follow-up period of 4.84 years, 4832 patients developed IDA. The incidence of IDA was significantly lower in the metformin group (26.08/1000 person-years) than in the non-metformin group (43.20/1000 person-years). Among the three groups divided by the proportion of days covered by metformin, we found a negative correlation between the proportion of days covered by metformin and the risk of IDA. The risk of IDA in patients with a proportion of days covered by metformin of <20%, 20–79%, and ≥80% was 0.43 (0.38, 0.48), 0.37 (0.34, 0.42), and 0.91 (0.85, 0.98), respectively, compared to the non-metformin group. We also performed subgroup analyses and sensitivity analyses: the incidence of IDA in the metformin group was lower than that in the non-metformin group in all subgroups, and the protective effect was more significant in subgroups of patients aged ≥65, with Charlson comorbidity index (CCI) ≥2, and with gastric acid inhibitor use. Conclusions: In Chinese patients with T2DM, metformin treatment was associated with a decreased risk of IDA admission, and this risk responded positively to the proportion of days covered by metformin. These findings suggest that metformin may have a pleiotropic effect on IDA in patients with type 2 diabetes. Our study has important clinical implications for the management of patients with diabetes and other conditions that increase the risk of IDA.
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spelling pubmed-103858222023-07-30 Association of Metformin Use with Iron Deficiency Anemia in Urban Chinese Patients with Type 2 Diabetes Wu, Junhui Yang, Ruotong Yu, Huan Qin, Xueying Wu, Tao Wu, Yiqun Hu, Yonghua Nutrients Article Background: Previous evidence yielded contradictory findings on the relationship between metformin and anemia. This study aims to assess whether metformin use is associated with iron-deficiency anemia (IDA) risk in patients with type 2 diabetes (T2D) in Beijing, China. Methods: Overall, 60,327 newly diagnosed T2D patients were included based on a historical cohort study design. The information pertaining to these patients was gathered from the Beijing Medical Claim Data for Employees Database. These patients were then categorized into the metformin and non-metformin groups and matched on a 1:1 propensity score based on their initial antidiabetic prescription. The Cox proportional hazards models were utilized to calculate the incidences and the hazard ratios (HRs). Results: The study enrolled 27,960 patients with type 2 diabetes, with 13,980 patients in each of the initial glucose-lowering prescription groups: metformin and non-metformin. During a median follow-up period of 4.84 years, 4832 patients developed IDA. The incidence of IDA was significantly lower in the metformin group (26.08/1000 person-years) than in the non-metformin group (43.20/1000 person-years). Among the three groups divided by the proportion of days covered by metformin, we found a negative correlation between the proportion of days covered by metformin and the risk of IDA. The risk of IDA in patients with a proportion of days covered by metformin of <20%, 20–79%, and ≥80% was 0.43 (0.38, 0.48), 0.37 (0.34, 0.42), and 0.91 (0.85, 0.98), respectively, compared to the non-metformin group. We also performed subgroup analyses and sensitivity analyses: the incidence of IDA in the metformin group was lower than that in the non-metformin group in all subgroups, and the protective effect was more significant in subgroups of patients aged ≥65, with Charlson comorbidity index (CCI) ≥2, and with gastric acid inhibitor use. Conclusions: In Chinese patients with T2DM, metformin treatment was associated with a decreased risk of IDA admission, and this risk responded positively to the proportion of days covered by metformin. These findings suggest that metformin may have a pleiotropic effect on IDA in patients with type 2 diabetes. Our study has important clinical implications for the management of patients with diabetes and other conditions that increase the risk of IDA. MDPI 2023-07-08 /pmc/articles/PMC10385822/ /pubmed/37513498 http://dx.doi.org/10.3390/nu15143081 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Wu, Junhui
Yang, Ruotong
Yu, Huan
Qin, Xueying
Wu, Tao
Wu, Yiqun
Hu, Yonghua
Association of Metformin Use with Iron Deficiency Anemia in Urban Chinese Patients with Type 2 Diabetes
title Association of Metformin Use with Iron Deficiency Anemia in Urban Chinese Patients with Type 2 Diabetes
title_full Association of Metformin Use with Iron Deficiency Anemia in Urban Chinese Patients with Type 2 Diabetes
title_fullStr Association of Metformin Use with Iron Deficiency Anemia in Urban Chinese Patients with Type 2 Diabetes
title_full_unstemmed Association of Metformin Use with Iron Deficiency Anemia in Urban Chinese Patients with Type 2 Diabetes
title_short Association of Metformin Use with Iron Deficiency Anemia in Urban Chinese Patients with Type 2 Diabetes
title_sort association of metformin use with iron deficiency anemia in urban chinese patients with type 2 diabetes
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10385822/
https://www.ncbi.nlm.nih.gov/pubmed/37513498
http://dx.doi.org/10.3390/nu15143081
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