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Solini A, Tricò D. Clinical efficacy and cost-effectiveness of metformin in different patient populations: A narrative review of real-world evidence. Diabetes Obes Metab 2024. [PMID: 38939954 DOI: 10.1111/dom.15729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/03/2024] [Accepted: 06/03/2024] [Indexed: 06/29/2024]
Abstract
Over the past two decades, diabetes pharmacopoeia has flourished, with new drugs that, on top of their glucose-lowering efficacy, have been shown to protect the heart and the kidney. Despite these new opportunities, metformin retains a pivotal role among glucose-lowering agents. As one of the few available insulin sensitizers, metformin is an effective, safe, and overall well-tolerated drug backed by over 60 years of clinical experience, including evidence for potential benefits beyond glucose reduction across different ages, sexes, genetic backgrounds, geographical areas, and stages of disease. Although there is some discussion of whether metformin offers the most effective front-line option in newly diagnosed type 2 diabetes (T2D), it remains a natural companion to all other glucose-lowering agents. Furthermore, metformin comes at a very low cost and, as such, it has extremely high cost-effectiveness, particularly given the serious economic burden associated with diabetes complications. This financial advantage is particularly relevant in resource-constrained healthcare systems, where the affordability of metformin may be instrumental in implementing an effective treatment in an evergrowing number of individuals. We present here compelling real-world evidence in support of the clinical efficacy and cost-effectiveness of metformin across different patient populations, highlighting areas where more population-based studies are needed to further incorporate and consolidate its use in the pharmacological management of T2D.
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Affiliation(s)
- Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Domenico Tricò
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Li Y, Liu X, Lv W, Wang X, Du Z, Liu X, Meng F, Jin S, Wen S, Bai R, Liu N, Tang R. Metformin use correlated with lower risk of cardiometabolic diseases and related mortality among US cancer survivors: evidence from a nationally representative cohort study. BMC Med 2024; 22:269. [PMID: 38926749 PMCID: PMC11210152 DOI: 10.1186/s12916-024-03484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND In the USA, the prolonged effective survival of cancer population has brought significant attention to the rising risk of cardiometabolic morbidity and mortality in this population. This heightened risk underscores the urgent need for research into effective pharmacological interventions for cancer survivors. Notably, metformin, a well-known metabolic regulator with pleiotropic effects, has shown protective effects against cardiometabolic disorders in diabetic individuals. Despite these promising indications, evidence supporting its efficacy in improving cardiometabolic outcomes in cancer survivors remains scarce. METHODS A prospective cohort was established using a nationally representative sample of cancer survivors enrolled in the US National Health and Nutrition Examination Survey (NHANES), spanning 2003 to 2018. Outcomes were derived from patient interviews, physical examinations, and public-access linked mortality archives up to 2019. The Oxidative Balance Score was utilized to assess participants' levels of oxidative stress. To evaluate the correlations between metformin use and the risk of cardiometabolic diseases and related mortality, survival analysis of cardiometabolic mortality was performed by Cox proportional hazards model, and cross-sectional analysis of cardiometabolic diseases outcomes was performed using logistic regression models. Interaction analyses were conducted to explore the specific pharmacological mechanism of metformin. RESULTS Among 3995 cancer survivors (weighted population, 21,671,061, weighted mean [SE] age, 62.62 [0.33] years; 2119 [53.04%] females; 2727 [68.26%] Non-Hispanic White individuals), 448 reported metformin usage. During the follow-up period of up to 17 years (median, 6.42 years), there were 1233 recorded deaths, including 481 deaths from cardiometabolic causes. Multivariable models indicated that metformin use was associated with a lower risk of all-cause (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.47-0.81) and cardiometabolic (HR, 0.65; 95% CI, 0.44-0.97) mortality compared with metformin nonusers. Metformin use was also correlated with a lower risk of total cardiovascular disease (odds ratio [OR], 0.41; 95% CI, 0.28-0.59), stroke (OR, 0.44; 95% CI, 0.26-0.74), hypertension (OR, 0.27; 95% CI, 0.14-0.52), and coronary heart disease (OR, 0.41; 95% CI, 0.21-0.78). The observed inverse associations were consistent across subgroup analyses in four specific cancer populations identified as cardiometabolic high-risk groups. Interaction analyses suggested that metformin use as compared to non-use may counter-balance oxidative stress. CONCLUSIONS In this cohort study involving a nationally representative population of US cancer survivors, metformin use was significantly correlated with a lower risk of cardiometabolic diseases, all-cause mortality, and cardiometabolic mortality.
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Affiliation(s)
- Yukun Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China
| | - Xiaoying Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China
| | - Wenhe Lv
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China
| | - Xuesi Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China
| | - Zhuohang Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China
| | - Xinmeng Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China
| | - Fanchao Meng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China
| | - Shuqi Jin
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China
| | - Songnan Wen
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ, 85259, USA
| | - Rong Bai
- Banner University Medical Center Phoenix, College of Medicine University of Arizona, Phoenix, AZ, 85123, USA.
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China.
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China.
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China.
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China.
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Aizenshtadt A, Wang C, Abadpour S, Menezes PD, Wilhelmsen I, Dalmao-Fernandez A, Stokowiec J, Golovin A, Johnsen M, Combriat TMD, Røberg-Larsen H, Gadegaard N, Scholz H, Busek M, Krauss SJK. Pump-Less, Recirculating Organ-on-Chip (rOoC) Platform to Model the Metabolic Crosstalk between Islets and Liver. Adv Healthc Mater 2024; 13:e2303785. [PMID: 38221504 DOI: 10.1002/adhm.202303785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/05/2023] [Indexed: 01/16/2024]
Abstract
Type 2 diabetes mellitus (T2DM), obesity, and metabolic dysfunction-associated steatotic liver disease (MASLD) are epidemiologically correlated disorders with a worldwide growing prevalence. While the mechanisms leading to the onset and development of these conditions are not fully understood, predictive tissue representations for studying the coordinated interactions between central organs that regulate energy metabolism, particularly the liver and pancreatic islets, are needed. Here, a dual pump-less recirculating organ-on-chip platform that combines human pluripotent stem cell (sc)-derived sc-liver and sc-islet organoids is presented. The platform reproduces key aspects of the metabolic cross-talk between both organs, including glucose levels and selected hormones, and supports the viability and functionality of both sc-islet and sc-liver organoids while preserving a reduced release of pro-inflammatory cytokines. In a model of metabolic disruption in response to treatment with high lipids and fructose, sc-liver organoids exhibit hallmarks of steatosis and insulin resistance, while sc-islets produce pro-inflammatory cytokines on-chip. Finally, the platform reproduces known effects of anti-diabetic drugs on-chip. Taken together, the platform provides a basis for functional studies of obesity, T2DM, and MASLD on-chip, as well as for testing potential therapeutic interventions.
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Affiliation(s)
- Aleksandra Aizenshtadt
- Hybrid Technology Hub Centre of Excellence, Institute of Basic Medical Science, University of Oslo, P.O. Box 1110, Oslo, 0317, Norway
- Dep. of Immunology and Transfusion Medicine, Oslo University Hospital, P.O. Box 4950, Oslo, 0424, Norway
| | - Chencheng Wang
- Hybrid Technology Hub Centre of Excellence, Institute of Basic Medical Science, University of Oslo, P.O. Box 1110, Oslo, 0317, Norway
- Dep. of Transplantation Medicine, Experimental Cell Transplantation Research Group, Oslo University Hospital, P.O. Box 4950, Oslo, 0424, Norway
| | - Shadab Abadpour
- Hybrid Technology Hub Centre of Excellence, Institute of Basic Medical Science, University of Oslo, P.O. Box 1110, Oslo, 0317, Norway
- Dep. of Transplantation Medicine, Experimental Cell Transplantation Research Group, Oslo University Hospital, P.O. Box 4950, Oslo, 0424, Norway
- Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
| | - Pedro Duarte Menezes
- Hybrid Technology Hub Centre of Excellence, Institute of Basic Medical Science, University of Oslo, P.O. Box 1110, Oslo, 0317, Norway
- James Watt School of Engineering, University of Glasgow, Rankine Building, Glasgow, G12 8LT, UK
| | - Ingrid Wilhelmsen
- Hybrid Technology Hub Centre of Excellence, Institute of Basic Medical Science, University of Oslo, P.O. Box 1110, Oslo, 0317, Norway
- Dep. of Immunology and Transfusion Medicine, Oslo University Hospital, P.O. Box 4950, Oslo, 0424, Norway
| | - Andrea Dalmao-Fernandez
- Hybrid Technology Hub Centre of Excellence, Institute of Basic Medical Science, University of Oslo, P.O. Box 1110, Oslo, 0317, Norway
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box 1083, Oslo, 0316, Norway
| | - Justyna Stokowiec
- Hybrid Technology Hub Centre of Excellence, Institute of Basic Medical Science, University of Oslo, P.O. Box 1110, Oslo, 0317, Norway
- Dep. of Immunology and Transfusion Medicine, Oslo University Hospital, P.O. Box 4950, Oslo, 0424, Norway
| | - Alexey Golovin
- Hybrid Technology Hub Centre of Excellence, Institute of Basic Medical Science, University of Oslo, P.O. Box 1110, Oslo, 0317, Norway
- Dep. of Immunology and Transfusion Medicine, Oslo University Hospital, P.O. Box 4950, Oslo, 0424, Norway
| | - Mads Johnsen
- Section for Chemical Life Sciences, Department of Chemistry, University of Oslo, P.O. Box 1033, Oslo, 0315, Norway
| | - Thomas M D Combriat
- Hybrid Technology Hub Centre of Excellence, Institute of Basic Medical Science, University of Oslo, P.O. Box 1110, Oslo, 0317, Norway
| | - Hanne Røberg-Larsen
- Hybrid Technology Hub Centre of Excellence, Institute of Basic Medical Science, University of Oslo, P.O. Box 1110, Oslo, 0317, Norway
- Section for Chemical Life Sciences, Department of Chemistry, University of Oslo, P.O. Box 1033, Oslo, 0315, Norway
| | - Nikolaj Gadegaard
- Hybrid Technology Hub Centre of Excellence, Institute of Basic Medical Science, University of Oslo, P.O. Box 1110, Oslo, 0317, Norway
- James Watt School of Engineering, University of Glasgow, Rankine Building, Glasgow, G12 8LT, UK
| | - Hanne Scholz
- Hybrid Technology Hub Centre of Excellence, Institute of Basic Medical Science, University of Oslo, P.O. Box 1110, Oslo, 0317, Norway
- Dep. of Transplantation Medicine, Experimental Cell Transplantation Research Group, Oslo University Hospital, P.O. Box 4950, Oslo, 0424, Norway
| | - Mathias Busek
- Hybrid Technology Hub Centre of Excellence, Institute of Basic Medical Science, University of Oslo, P.O. Box 1110, Oslo, 0317, Norway
- Dep. of Immunology and Transfusion Medicine, Oslo University Hospital, P.O. Box 4950, Oslo, 0424, Norway
| | - Stefan J K Krauss
- Hybrid Technology Hub Centre of Excellence, Institute of Basic Medical Science, University of Oslo, P.O. Box 1110, Oslo, 0317, Norway
- Dep. of Immunology and Transfusion Medicine, Oslo University Hospital, P.O. Box 4950, Oslo, 0424, Norway
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