Early HbA1c benefits from metformin lowers risk of cardiovascular events

People with type 2 diabetes who begin metformin treatment and achieve better HbA1c levels within six months are less likely to experience cardiovascular events or death, a new study finds.
Scientists from Aarhus University Hospital in Denmark also found that failure to achieve significant HbA1c improvements during the time was a predictor for increased risk of cardiovascular complications.
“Among patients with type 2 diabetes who initiate their first metformin treatment, achievement of good early glycemic control and large HbA1c reduction predicts decreased risk of CV outcomes and death,” lead researcher Reimar Wernich Thomse, MD, PhD told Endocrine Today.
“Poor early glycemic response provides an important prediction tool for identification of patient subgroups with type 2 diabetes who have increased risk for CV complications and death.”
A total of 24,572 people with type 2 diabetes who took metformin were involved in this research between 2000 and 2012. All participants were aged over 30 years.
Participants were classified by HbA1c levels of 47.5 mmol/mol (6.5%) at six months after initiation of metformin, with the average follow-up time 2.6 years.
Those who achieved HbA1c levels lower than 47.5 mmol/mol had the lowest risk of myocardial infarctio, stroke or death. Participants with HbA1c levels of 63.9 mmol/mol (8%) had the highest risk.
The greatest cardiovascular benefits were observed among participants who had the largest HbA1c reductions, with researchers now looking to analyse the mechanics of this association.
“Studies that can clarify whether this association is caused by better early glucose-lowering therapy (e.g., more intensive therapy or better patient adherence) or by a different pathological trajectory/milder variant of type 2 diabetes in those patients who are rapid glycemic responders [are needed],” the authors wrote.
The findings have been published online in the journal Diabetes Care.