Is metformin safe for older adults?

  • Solymár M & al.
  • PLoS ONE
  • 1 Jan 2018

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Metformin appears safe for treating type 2 diabetes (T2D) in adults aged ≥60 years.

Why this matters

  • T2D prevalence is increasing among the elderly, raising the concern that the first-line agent metformin could exaggerate the severity of aging anorexia.

Study design

  • Meta-analysis of 6 randomized, placebo-controlled trials, including 1541 participants aged ≥60 years.  
  • Funding: Hungarian National Research, Development and Innovation Office.

Key results

  • Raw body weight change difference between metformin and placebo groups was −2.23 kg (P<.001>
  • HbA1c dropped by an average of 0.49 percentage points vs placebo (P<.001>
  • Total cholesterol decreased significantly with metformin (−0.184 mmol/L; P<.001>
  • Low-density lipoprotein cholesterol declined significantly following addition of metformin to other treatments (−0.182 mmol/L; P<.001>
  • High-density lipoprotein cholesterol, serum triglycerides, and diastolic BP did not change with metformin.
  • Mild gastrointestinal adverse effects/digestive tracts symptoms, nonsevere hypoglycemia, and discontinuation because of adverse effects appeared more common with metformin vs placebo in some studies.

Limitations

  • No subgroup or meta-regression analyses could be performed, i.e., by age group above 60.  
  • Dropout effects not always assessed.
  • All studies performed in US or Western Europe.
  • No data for those prescribed metformin for reasons other than T2D.
  • Meta-analysis search focused only on body weight change, not lipids.

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