| Title |
Mortality Associated with Metformin Versus Sulfonylurea Initiation: A Cohort Study of Veterans with Diabetes and Chronic Kidney Disease
|
|---|---|
| Published in |
Journal of General Internal Medicine, November 2017
|
| DOI | 10.1007/s11606-017-4219-3 |
| Pubmed ID | |
| Authors |
Zachary A. Marcum, Christopher W. Forsberg, Kathryn P. Moore, Ian H. de Boer, Nicholas L. Smith, Edward J. Boyko, James S. Floyd |
| Abstract |
For patients with type 2 diabetes and chronic kidney disease (CKD), high-quality evidence about the relative benefits and harms of oral glucose-lowering drugs is limited. To evaluate whether mortality risk differs after the initiation of monotherapy with either metformin or a sulfonylurea in Veterans with type 2 diabetes and CKD. Observational, national cohort study in the Veterans Health Administration (VHA). Veterans who received care from the VHA for at least 1 year prior to initiating monotherapy treatment for type 2 diabetes with either metformin or a sulfonylurea between 2004 and 2009. Metformin and sulfonylurea use was assessed from VHA electronic pharmacy records. The CKD-EPI equation was used to estimate glomerular filtration rate (eGFR). The outcome of death from January 1, 2004, through December 31, 2009, was assessed from VHA Vital Status files. Among 175,296 new users of metformin or a sulfonylurea monotherapy, 5121 deaths were observed. In primary analyses adjusted for all measured potential confounding factors, metformin monotherapy was associated with a lower mortality hazard ratio (HR) compared with sulfonylurea monotherapy across all ranges of eGFR evaluated (HR ranging from 0.59 to 0.80). A secondary analysis of mortality risk differences favored metformin across all eGFR ranges; the greatest risk difference was observed in the eGFR category 30-44 mL/min/1.73m2 (12.1 fewer deaths/1000 person-years, 95% CI 5.2-19.0). Initiation of metformin versus a sulfonylurea among individuals with type 2 diabetes and CKD was associated with a substantial reduction in mortality, in terms of both relative and absolute risk reduction. The largest absolute risk reduction was observed among individuals with moderately-severely reduced eGFR (30-44 mL/min/1.73m2). |
X Demographics
The data shown below were collected from the profiles of 67 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Spain | 17 | 25% |
| United States | 6 | 9% |
| United Kingdom | 5 | 7% |
| India | 3 | 4% |
| South Africa | 2 | 3% |
| Poland | 1 | 1% |
| Uruguay | 1 | 1% |
| Egypt | 1 | 1% |
| Portugal | 1 | 1% |
| Other | 3 | 4% |
| Unknown | 27 | 40% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 46 | 69% |
| Practitioners (doctors, other healthcare professionals) | 14 | 21% |
| Scientists | 6 | 9% |
| Science communicators (journalists, bloggers, editors) | 1 | 1% |
Mendeley readers
The data shown below were compiled from readership statistics for 63 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 63 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Ph. D. Student | 8 | 13% |
| Student > Master | 8 | 13% |
| Student > Bachelor | 6 | 10% |
| Professor | 4 | 6% |
| Researcher | 4 | 6% |
| Other | 13 | 21% |
| Unknown | 20 | 32% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 24 | 38% |
| Pharmacology, Toxicology and Pharmaceutical Science | 6 | 10% |
| Nursing and Health Professions | 5 | 8% |
| Biochemistry, Genetics and Molecular Biology | 1 | 2% |
| Agricultural and Biological Sciences | 1 | 2% |
| Other | 4 | 6% |
| Unknown | 22 | 35% |
Attention Score in Context
This research output has an Altmetric Attention Score of 47. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 08 November 2019.
All research outputs
#853,317
of 24,733,536 outputs
Outputs from Journal of General Internal Medicine
#701
of 7,998 outputs
Outputs of similar age
#19,686
of 449,116 outputs
Outputs of similar age from Journal of General Internal Medicine
#8
of 84 outputs
Altmetric has tracked 24,733,536 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 96th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 7,998 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 22.2. This one has done particularly well, scoring higher than 91% of its peers.
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We're also able to compare this research output to 84 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 91% of its contemporaries.