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Impact of metformin on cardiovascular disease: a meta-analysis of randomised trials among people with type 2 diabetes

Overview of attention for article published in Diabetologia, August 2017
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (93rd percentile)
  • High Attention Score compared to outputs of the same age and source (87th percentile)

Mentioned by

news
1 news outlet
twitter
54 tweeters

Citations

dimensions_citation
85 Dimensions

Readers on

mendeley
148 Mendeley
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Title
Impact of metformin on cardiovascular disease: a meta-analysis of randomised trials among people with type 2 diabetes
Published in
Diabetologia, August 2017
DOI 10.1007/s00125-017-4337-9
Pubmed ID
Authors

Simon J. Griffin, James K. Leaver, Greg J. Irving

Abstract

Metformin is the most-prescribed oral medication to lower blood glucose worldwide. Yet previous systematic reviews have raised doubts about its effectiveness in reducing risk of cardiovascular disease, the most costly complication of type 2 diabetes. We aimed to systematically identify and pool randomised trials reporting cardiovascular outcomes in which the effect of metformin was 'isolated' through comparison to diet, lifestyle or placebo. We performed an electronic literature search of MEDLINE, EMBASE and the Cochrane Library. We also manually screened the reference lists of previous meta-analyses of trials of metformin identified through a MEDLINE search. We included randomised controlled trials of adults with type 2 diabetes comparing any dose and preparation of oral metformin with no intervention, placebo or a lifestyle intervention and reporting mortality or a cardiovascular outcome. We included ten articles reporting 13 trials (including a total of 2079 individuals with type 2 diabetes allocated to metformin and a similar number to comparison groups) of which only four compared metformin with placebo and collected data on cardiovascular outcomes. Participants were mainly white, aged ≤65 years, overweight/obese and with poor glycaemic control. Summary estimates were based on a small number of events: 416 myocardial infarctions/ischaemic heart disease events in seven studies and 111 strokes in four studies. The UK Prospective Diabetes Study (UKPDS) contributed the majority of data to the summary estimates, with weights ranging from 52.3% for myocardial infarction to 70.5% for stroke. All outcomes, with the exception of stroke, favoured metformin, with limited heterogeneity between studies, but none achieved statistical significance. Effect sizes (Mantel-Haenszel RR) were: all-cause mortality 0.96 (95% CI 0.84, 1.09); cardiovascular death 0.97 (95% CI 0.80, 1.16); myocardial infarction 0.89 (95% CI 0.75, 1.06); stroke 1.04 (95% CI 0.73, 1.48); and peripheral vascular disease 0.81 (95% CI 0.50, 1.31). There remains uncertainty about whether metformin reduces risk of cardiovascular disease among patients with type 2 diabetes, for whom it is the recommended first-line drug. Although this is mainly due to absence of evidence, it is unlikely that a definitive placebo-controlled cardiovascular endpoint trial among people with diabetes will be forthcoming. Alternative approaches to reduce the uncertainty include the use of electronic health records in long-term pragmatic evaluations, inclusion of metformin in factorial trials, publication of cardiovascular outcome data from adverse event reporting in trials of metformin and a cardiovascular endpoint trial of metformin among people without diabetes.

Twitter Demographics

The data shown below were collected from the profiles of 54 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 148 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 148 100%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 24 16%
Unspecified 23 16%
Researcher 21 14%
Student > Master 21 14%
Other 20 14%
Other 38 26%
Unknown 1 <1%
Readers by discipline Count As %
Medicine and Dentistry 51 34%
Unspecified 32 22%
Biochemistry, Genetics and Molecular Biology 14 9%
Nursing and Health Professions 13 9%
Pharmacology, Toxicology and Pharmaceutical Science 12 8%
Other 25 17%
Unknown 1 <1%

Attention Score in Context

This research output has an Altmetric Attention Score of 39. 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 09 May 2019.
All research outputs
#456,669
of 13,740,867 outputs
Outputs from Diabetologia
#296
of 3,897 outputs
Outputs of similar age
#17,075
of 267,507 outputs
Outputs of similar age from Diabetologia
#10
of 77 outputs
Altmetric has tracked 13,740,867 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 3,897 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 17.4. This one has done particularly well, scoring higher than 92% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 267,507 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 93% of its contemporaries.
We're also able to compare this research output to 77 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 87% of its contemporaries.