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Efficacy and safety of metformin in the management of type 2 diabetes mellitus in older adults: a systematic review for the development of recommendations to reduce potentially inappropriate prescribing

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dc.contributor.author Schlender, Lisa
dc.contributor.author Martinez, Yolanda V.
dc.contributor.author Adeniji, Charles
dc.contributor.author Reeves, David
dc.contributor.author Faller, Barbara
dc.contributor.author Sommerauer, Christina
dc.contributor.author Al Qur’an, Thekraiat
dc.contributor.author Woodham, Adrine
dc.contributor.author Kunnamo, Ilkka
dc.contributor.author Sönnichsen, Andreas
dc.contributor.author Renom-Guiteras, Anna
dc.date.accessioned 2018-04-16T07:29:55Z
dc.date.available 2018-04-16T07:29:55Z
dc.date.issued 2017
dc.identifier.citation Schlender L, Martinez YV, Adeniji C, Reeves D, Faller B, Sommerauer C. et al. Efficacy and safety of metformin in the management of type 2 diabetes mellitus in older adults: a systematic review for the development of recommendations to reduce potentially inappropriate prescribing. BMC Geriatr. 2017 Oct 16;17(Suppl 1):227. DOI: 10.1186/s12877-017-0574-5
dc.identifier.issn 1471-2318
dc.identifier.uri http://hdl.handle.net/10230/34354
dc.description.abstract BACKGROUND: Metformin is usually prescribed as first line therapy for type 2 diabetes mellitus (DM2). However, the benefits and risks of metformin may be different for older people. This systematic review examined the available evidence on the safety and efficacy of metformin in the management of DM2 in older adults. The findings were used to develop recommendations for the electronic decision support tool of the European project PRIMA-eDS. METHODS: The systematic review followed a staged approach, initially searching for systematic reviews and meta-analyses first, and then individual studies when prior searches were inconclusive. The target population was older people (≥65 years old) with DM2. Studies were included if they reported safety or efficacy outcomes with metformin (alone or in combination) for the management of DM2 compared to placebo, usual or no treatment, or other antidiabetics. Using the evidence identified, recommendations were developed using GRADE methodology. RESULTS: Fifteen studies were included (4 intervention and 11 observational studies). In ten studies at least 80% of participants were 65 years or older and 5 studies reported subgroup analyses by age. Comorbidities were reported by 9 studies, cognitive status was reported by 4 studies and functional status by 1 study. In general, metformin showed similar or better safety and efficacy than other specific or non-specific active treatments. However, these findings were mainly based on retrospective observational studies. Four recommendations were developed suggesting to discontinue the use of metformin for the management of DM2 in older adults with risk factors such as age > 80, gastrointestinal complaints during the last year and/or GFR ≤60 ml/min. CONCLUSIONS: On the evidence available, the safety and efficacy profiles of metformin appear to be better, and certainly no worse, than other treatments for the management of DM2 in older adults. However, the quality and quantity of the evidence is low, with scarce data on adverse events such as gastrointestinal complaints or renal failure. Further studies are needed to more reliably assess the benefits and risks of metformin in very old (>80), cognitively and functionally impaired older people
dc.description.sponsorship The PRIMA-eDS study was supported by a grant from the European Commission within the 7th Framework Programme (Grant No. 305388–2). The work of YVM was also supported by a grant from the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre. Publication of this article was funded by the UK National Institute for Health Research School for Primary Care Research, University of Manchester
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher BioMed Central
dc.rights Copyright © The Author(s). 2017. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
dc.rights.uri http://creativecommons.org/licenses/by/4.0/
dc.subject.other Diabetis -- Tractament
dc.subject.other Persones grans -- Malalties
dc.title Efficacy and safety of metformin in the management of type 2 diabetes mellitus in older adults: a systematic review for the development of recommendations to reduce potentially inappropriate prescribing
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1186/s12877-017-0574-5
dc.subject.keyword Elder
dc.subject.keyword Elderly
dc.subject.keyword Inappropriate prescribing
dc.subject.keyword Metformin
dc.subject.keyword Older people
dc.subject.keyword Systematic review
dc.subject.keyword Type 2 diabetes mellitus
dc.relation.projectID info:eu-repo/grantAgreement/EC/FP7/305388
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion


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