Association between clinical outcomes and metformin use in adults with sickle cell disease and diabetes mellitus

Sherif M. Badawy*, Amanda B. Payne

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Metformin was recently found to increase fetal hemoglobin, which is protective in sickle cell disease (SCD). We tested the hypothesis that, among adults with SCD and diabetes mellitus (DM), metformin use is associated with fewer adverse SCD clinical outcomes and lower health care utilization. This is a retrospective cohort study using the MarketScan Medicaid claims database for 2006 to 2016, comparing metformin users and nonusers. Patients on hydroxyurea, insulin, or iron chelation were excluded. Main outcomes included annual rates of all-cause inpatient encounters, all-cause emergency department (ED) encounters, inpatient and ED encounters with SCD codes, vaso-occlusive episodes (VOEs), strokes, acute chest syndrome (ACS), avascular necrosis (AVN), and gallstones. Of 457 adults (median age [interquartile range], 43 years [33-52 years]; 72% female), 142 (31%) were treated with metformin. Adjusted for age, sex, and Charlson Comorbidity Index, metformin users had significantly lower rate ratios of all-cause inpatient encounters (0.68; 95% confidence interval [CI], 0.52-0.88; P, .01), inpatient encounters with SCD codes (0.45; 95% CI, 0.30-0.66; P, .01), ED encounters with SCD codes (0.34; 95% CI, 0.21-0.54; P, .01), VOE (0.22; 95% CI, 0.12-0.41; P, .01), ACS (0.17; 95% CI, 0.05-0.60; P 5 .01), and AVN (0.30; 95% CI, 0.11-0.87; P 5 .03). A subgroup analysis of 54 enrollees preinitiation and postinitiation of metformin did not indicate significant changes in rates of clinical events. Metformin was associated with significantly fewer inpatient and ED SCD encounters in adults with SCD and DM; however, confounding of underlying SCD severity cannot be excluded.

Original languageEnglish (US)
Pages (from-to)3297-3306
Number of pages10
JournalBlood Advances
Volume3
Issue number21
DOIs
StatePublished - Nov 12 2019

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Metformin
Sickle Cell Anemia
Diabetes Mellitus
Inpatients
Confidence Intervals
Hospital Emergency Service
Acute Chest Syndrome
Necrosis
Patient Acceptance of Health Care
Fetal Hemoglobin
Hydroxyurea
Medicaid
Gallstones
Comorbidity
Cohort Studies
Iron
Retrospective Studies
Stroke
Databases
Insulin

ASJC Scopus subject areas

  • Hematology

Cite this

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title = "Association between clinical outcomes and metformin use in adults with sickle cell disease and diabetes mellitus",
abstract = "Metformin was recently found to increase fetal hemoglobin, which is protective in sickle cell disease (SCD). We tested the hypothesis that, among adults with SCD and diabetes mellitus (DM), metformin use is associated with fewer adverse SCD clinical outcomes and lower health care utilization. This is a retrospective cohort study using the MarketScan Medicaid claims database for 2006 to 2016, comparing metformin users and nonusers. Patients on hydroxyurea, insulin, or iron chelation were excluded. Main outcomes included annual rates of all-cause inpatient encounters, all-cause emergency department (ED) encounters, inpatient and ED encounters with SCD codes, vaso-occlusive episodes (VOEs), strokes, acute chest syndrome (ACS), avascular necrosis (AVN), and gallstones. Of 457 adults (median age [interquartile range], 43 years [33-52 years]; 72{\%} female), 142 (31{\%}) were treated with metformin. Adjusted for age, sex, and Charlson Comorbidity Index, metformin users had significantly lower rate ratios of all-cause inpatient encounters (0.68; 95{\%} confidence interval [CI], 0.52-0.88; P, .01), inpatient encounters with SCD codes (0.45; 95{\%} CI, 0.30-0.66; P, .01), ED encounters with SCD codes (0.34; 95{\%} CI, 0.21-0.54; P, .01), VOE (0.22; 95{\%} CI, 0.12-0.41; P, .01), ACS (0.17; 95{\%} CI, 0.05-0.60; P 5 .01), and AVN (0.30; 95{\%} CI, 0.11-0.87; P 5 .03). A subgroup analysis of 54 enrollees preinitiation and postinitiation of metformin did not indicate significant changes in rates of clinical events. Metformin was associated with significantly fewer inpatient and ED SCD encounters in adults with SCD and DM; however, confounding of underlying SCD severity cannot be excluded.",
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Association between clinical outcomes and metformin use in adults with sickle cell disease and diabetes mellitus. / Badawy, Sherif M.; Payne, Amanda B.

In: Blood Advances, Vol. 3, No. 21, 12.11.2019, p. 3297-3306.

Research output: Contribution to journalArticle

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AU - Payne, Amanda B.

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