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Dose-Dependent Relationship Between Long-Term Metformin Use and the Risk of Diabetic Retinopathy: A Population-Based
Yu-Ching Li1,2,3, Kuang-Hua Huang1, Yih Yang4
1Department of Health Services Administration, China Medical University, Taichung, Taiwan.
Clinical Drug Investigation
|February 12, 2025
Summary
Metformin use in diabetes mellitus patients shows a dual effect on diabetic retinopathy risk. Lower doses may reduce risk, while higher doses significantly increase it, indicating a dose-dependent relationship.
Area of Science:
- Endocrinology
- Ophthalmology
- Pharmacology
Background:
- Concerns exist regarding metformin's association with increased diabetic retinopathy risk.
- The dose-dependent effect of metformin on diabetic retinopathy remains unclear.
Purpose of the Study:
- To investigate the relationship between metformin treatment and diabetic retinopathy risk.
- To determine if metformin affects diabetic retinopathy risk in a dose-dependent manner.
Main Methods:
- Secondary analysis of a nationwide Taiwanese population database (2002-2013).
- Included patients aged 20+ with new-onset type 2 diabetes mellitus.
- Compared metformin users with sulfonylurea users using Cox proportional hazards models, analyzing cumulative defined daily dose and treatment intensity.
Main Results:
- Analysis included 241,231 metformin users and 152,617 sulfonylurea users.
- Lower cumulative metformin dose (<30 DDD) was associated with reduced diabetic retinopathy risk (aHR=0.77).
- Higher metformin doses (>25 DDD) were linked to a significantly increased risk (aHR=2.43) compared to sulfonylureas.
Conclusions:
- Lower cumulative metformin dosage in diabetes mellitus patients is linked to a reduced risk of diabetic retinopathy.
- Higher intensity of metformin use is associated with an elevated risk of diabetic retinopathy.
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