Recently, we reported on a new study suggesting that the drug metformin, which is widely used in the treatment of diabetes, could help reduce the side effects of steroids. Now a study published online in the medical journal JAMA Surgery indicates another possible benefit of metformin—it appears to shield diabetes patients from harmful complications after surgery.
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The title of the study is “Association Between Preoperative Metformin Exposure and Postoperative Outcomes in Adults With Type 2 Diabetes,” and it was done by Katherine Reitz, MD, and colleagues at the University of Pittsburgh School of Medicine. They described their analysis of over 10,000 patients with diabetes who had undergone a “major surgical intervention.” The researchers obtained their information from the electronic health records of a healthcare system in Pennsylvania. The data came from adults with diabetes who had undergone a major operation between January 1, 2010, and January 1, 2016, at 15 hospitals within the system, and the researchers followed up the patients until December 2018. Individuals who had had one or more prescriptions for metformin in the six months preceding their operations were counted in the metformin group. Among the patients with diabetes who had a major surgical intervention, 59% had preoperative metformin prescriptions. The average age of the subjects was 67.7 and the male-female ratio was about 50-50.
The researchers reported that patients who were prescribed metformin before surgery had a 27% lower risk for 90-day mortality than those who did not have presurgical metformin. The metformin patients also had lower readmission rates. The finding was considered especially important because it’s known that adults who have what’s known as “comorbid” factors (the existence of one or more other health concerns in addition to the primary one) have less of what doctors call “physiological reserve” and higher rates of hospital readmission and death after major surgery. Diabetes, of course, is one of those comorbid factors.
In an interview with the medical news service MedPage Today, Dr. Reitz said, “Metformin is actively being explored as both a preventative medication and treatment for numerous diseases in both diabetic and non-diabetic patients. These studies have shown promising results and we were hopeful that metformin would be effective for our surgical patients…. We were very surprised by both the magnitude and the strength of the positive effect associated with metformin therapy. If we conservatively estimate that 20 million major surgeries occur annually in the United States, our data would suggest metformin may help to reduce readmissions for 200,000 Americans and prolong the life of 10,000 each year.”
In an accompanying commentary on the article, Elizabeth George, MD, and Sherry Wren, MD, of the Stanford University School of Medicine observed, “This study demonstrates how variables besides coexisting medical diseases can affect surgical outcomes. Metformin now joins [beta]-blockers, statins, and immunonutrition as preoperative agents associated with improved surgical outcomes. It may be only a matter of time before optimization of postoperative outcomes with perioperative medications and supplements becomes a standard. To answer this question more completely, further analysis or future trials should factor in statin use, as well as whether medications are continued in the postoperative period.”