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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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  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (94th percentile)
  • High Attention Score compared to outputs of the same age and source (85th percentile)

Mentioned by

1 news outlet
75 tweeters


138 Dimensions

Readers on

222 Mendeley
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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

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


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 75 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 222 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 222 100%

Demographic breakdown

Readers by professional status Count As %
Researcher 37 17%
Student > Ph. D. Student 32 14%
Student > Master 26 12%
Other 26 12%
Student > Bachelor 23 10%
Other 36 16%
Unknown 42 19%
Readers by discipline Count As %
Medicine and Dentistry 73 33%
Pharmacology, Toxicology and Pharmaceutical Science 20 9%
Nursing and Health Professions 17 8%
Biochemistry, Genetics and Molecular Biology 16 7%
Agricultural and Biological Sciences 12 5%
Other 31 14%
Unknown 53 24%

Attention Score in Context

This research output has an Altmetric Attention Score of 54. 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 20 October 2020.
All research outputs
of 16,050,526 outputs
Outputs from Diabetologia
of 4,275 outputs
Outputs of similar age
of 273,774 outputs
Outputs of similar age from Diabetologia
of 77 outputs
Altmetric has tracked 16,050,526 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 97th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 4,275 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 18.9. This one has done particularly well, scoring higher than 93% 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 273,774 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 94% 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 85% of its contemporaries.