1. In this retrospective cohort study, individuals with diabetes treated with metformin had a significantly lower risk of developing osteoarthritis compared to those treated with sulfonylurea.

Evidence Rating Level: 2 (Good)

Osteoarthritis (OA) affects 32.5 million people in the United States and is a major contributor to global years lived with disability. Currently, there are no effective medications that can stop, slow, or reverse the progression of OA. In addition to its use as a first-line treatment for type 2 diabetes, there is emerging evidence that metformin may be useful in preventing OA. Previous observational studies have focused on the progression of OA rather than its initial development and failed to isolate metformin’s effect from concomitant antidiabetic medication use. This large retrospective cohort study aimed to fill these gaps by evaluating the risk of developing OA and requiring joint replacement in diabetic individuals treated with metformin compared to sulfonylurea. The study used the Optum Clinformatics Data Mart Database, a large deidentified nationwide database that includes more than 15 million individuals annually. From this dataset, 20 937 individuals aged 40 years or older with type 2 diabetes and no prior diagnosis of OA or previous joint replacement were identified for each treatment group. After adjusting for confounders, individuals who received metformin were 24% less likely to develop OA compared to those treated with a sulfonylurea (P < .001). However, there was no significant reduction in the risk of undergoing a joint replacement. In a stratified analysis comparing those treated with metformin alone versus those treated with a sulfonylurea with prior metformin use, there was no longer a statistically significant reduction in the risk of developing OA. This finding may suggest that previous exposure to metformin afforded some level of long-term protection against OA development. Overall, the study found a significant association between metformin treatment and a reduction in the risk of developing OA compared to sulfonylurea treatment, a finding that supports previous literature. The study was limited by a lack of data on body mass index, which is associated with OA development. Metformin treatment may induce a decrease in body mass index, which may account for its protective effect against the development of OA. Nevertheless, further studies on metformin as an intervention to treat or prevent OA should be considered, especially given the limited therapeutic options for OA currently.

Click to read the study in JAMA Network Open

Image: PD

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