RT Journal Article
SR Electronic
T1 Metformin use and associated risk of total joint replacement in patients with type 2 diabetes: a population-based matched cohort study
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E1672
OP E1684
DO 10.1503/cmaj.220952
VO 194
IS 49
A1 Zhaohua Zhu
A1 Jing-Yang Huang
A1 Guangfeng Ruan
A1 Peihua Cao
A1 Shibo Chen
A1 Yan Zhang
A1 Weiyu Han
A1 Tianyu Chen
A1 Xiaoyan Cai
A1 Jia Liu
A1 Yujin Tang
A1 Na Yu
A1 Qian Wang
A1 David J. Hunter
A1 James Cheng-Chung Wei
A1 Changhai Ding
YR 2022
UL http://www.cmaj.ca/content/194/49/E1672.abstract
AB Background: It is uncertain whether metformin use is associated with reduced risk of joint replacement in patients with type 2 diabetes mellitus. We aimed to establish whether metformin use was associated with a reduced risk of total knee replacement (TKR) or total hip replacement (THR) among these patients.Methods: We selected patients with type 2 diabetes mellitus that was diagnosed between 2000 and 2012 from the Taiwan National Health Insurance Research Database. We used prescription time-distribution matching and propensity-score matching to balance potential confounders between metformin users and nonusers. We assessed the risks of TKR or THR using Cox proportional hazards regression.Results: We included 20 347 participants who were not treated with metformin and 20 347 who were treated with metformin, for a total of 40 694 participants (mean age 63 yr, standard deviation 11 yr; 49.8% were women) after prescription time-distribution matching. Compared with participants who did not use metformin, those who used metformin had lower risks of TKR or THR (adjusted hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.60–0.81 for TKR or THR; adjusted HR 0.71, 95% CI 0.61–0.84 for TKR; adjusted HR 0.61, 95% CI 0.41–0.92 for THR) after adjustment for covariates. Propensity-score matching analyses (10 163 participants not treated with metformin v. 10 163 treated with metformin) and sensitivity analyses using inverse probability of treatment weighting and competing risk regression showed similar results.Interpretation: Metformin use in patients with type 2 diabetes mellitus was associated with a significantly reduced risk of total joint replacement. Randomized controlled clinical trials in patients with osteoarthritis are warranted to determine whether metformin is effective in decreasing the need for joint replacement.