Evidence map›Metformin × cardiovascular events›PMID 23230096›Full record

Trial reportDiabetes care2013

Effects of metformin versus glipizide on cardiovascular outcomes in patients with type 2 diabetes and coronary artery disease.

Jie Hong, Yifei Zhang, Shenghan Lai, Ankang Lv, Qing Su, Yan Dong, Zhiguang Zhou, Weili Tang, Jiajun Zhao, Lianqun Cui and 11 more

Registry-linked trialOpen access · hybridAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Diabetes care, 2013. The graph read 1 number from its abstract, feeding 2 cells of the map: it supports the treatment in 2. It is linked to trial NCT03031821 (A Randomized Phase 3 Trial of Metformin in Patients Initiating Androgen Deprivation Therapy as Prevention and Intervention of Metabolic Syndrome), which is not on this map. Cited by 158 papers, 20 of them syntheses that pooled it.

1number the graph read from it
2cells of the map it votes in
158citing papers in PubMed, 20 pooled it
10.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

← favours the treatmentfavours the comparator →
0.51 · no effect
Cardiovascular eventsfavours the treatment · against placebo · ascvd, t2dfeeds 2 cells of the map
HR 0.540.30 to 0.90P = 0.026
Intention-to-treat analysis showed an adjusted hazard ratio (HR) of 0.54 (95% CI 0.30-0.90; P = 0.026) for the composites of cardiovascular events among the patients that received metformin, compared with glipizide.
FeedsMetformin×cardiovascular eventsSulfonylureas & glinides×cardiovascular events

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Metformin×cardiovascular events

SupportsOpen on the map →What to test next →

5 readable studies in this cell: 4 favour the treatment, 1 find no difference, 0 favour the comparator.

Belief with this paper
0.50contested · 4 families support, 2 contradict · against placebo
Without it
0.50This paper does not move the number.
← favours the treatmentfavours the comparator →
1 · no effect
This paper · 2013
HR 0.540.30 to 0.90
Protective effect of metformin on myocardial injury in metabolic syndr…PMID 24335026 · 2014
HR 0.250.10 to 0.62
Comparative effect of saxagliptin and glimepiride with a composite end…PMID 30520221 · 2019
OR 1.381.05 to 1.82

Sulfonylureas & glinides×cardiovascular events

SupportsOpen on the map →What to test next →

3 readable studies in this cell: 2 favour the treatment, 1 find no difference, 0 favour the comparator.

Belief with this paper
0.96replicated · 2 families support, 0 contradict · against placebo
Without it
0.50This paper moves it by +0.46. It would be one trial.
← favours the treatmentfavours the comparator →
1 · no effect
This paper · 2013
HR 0.540.30 to 0.90
Comparative effect of saxagliptin and glimepiride with a composite end…PMID 30520221 · 2019
OR 1.381.05 to 1.82
4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03031821 phase3terminatedstarted 2018, after this paper: background citation

A Randomized Phase 3 Trial of Metformin in Patients Initiating Androgen Deprivation Therapy as Prevention and Intervention of Metabolic Syndrome: The Prime Study

Ran2018Enrolled166Registered outcomes30Posted comparisons0ConditionsMetabolic Syndrome, Prostate CancerArmsMetformin, Placebo Oral Tablet
PMID 21933330PMID 20452916PMID 26633628PMID 9742977PMID 25017630PMID 8569826PMID 25456737PMID 24412228PMID 25536258PMID 23918942PMID 15838067PMID 7821128other papers from this trial
Open the trial in the graph
5 · Its place in the literature

Who cites it

158 citing papers in PubMed, 20 syntheses or guidelines pooled it, 355 citations in OpenAlex.

  1. Pooled it
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  5. Pooled it
  6. Guideline
  7. Pooled it
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  14. Metformin monotherapy for adults with type 2 diabetes mellitus.The Cochrane database of systematic reviews · 2020 · on this map
    Pooled it
  15. Guideline
  16. Guideline
  17. Pooled it
  18. Pooled it
  19. Pooled it
  20. Pooled it

98 more citing papers are in PubMed but not listed here.

6 · The record

Corrections and comments

7 · Who and what money

Authors and funding

21 authors at 15 institutions in 2 countries.

Jie HongShanghai Jiao Tong University School of Medicine, Shanghai, China.
Yifei Zhang
Shenghan Lai
Ankang Lv
Qing Su
Yan Dong
Zhiguang Zhou
Weili Tang
Jiajun Zhao
Lianqun Cui
Dajin Zou
Dawang Wang
Hong Li
Chao Liu
Guoting Wu
Jie Shen
Dalong Zhu
Weiqing Wang
Weifeng Shen
Guang Ning
SPREAD-DIMCAD Investigators
Shanghai Jiao Tong University · CNCentral South University · CNJiangsu Province Hospital · CNJohns Hopkins University · USNanfang Hospital · CNNanjing Drum Tower Hospital · CNRuijin Hospital · CNSecond Military Medical University · CNSecond Xiangya Hospital of Central South University · CNShandong Provincial Hospital · CNShandong University · CNShanghai Tenth People's Hospital · CNShanghai University of Traditional Chinese Medicine · CNSir Run Run Shaw Hospital · CNWenzhou Medical University · CN

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

objectiveThe two major classes of antidiabetic drugs, sulfonylureas and metformin, may differentially affect macrovascular complications and mortality in diabetic patients. We compared the long-term effects of glipizide and metformin on the major cardiovascular events in type 2 diabetic patients who had a history of coronary artery disease (CAD). RESEARCH DESIGN AND

methodsThis study is a multicenter, randomized, double-blind, placebo-controlled clinical trial. A total of 304 type 2 diabetic patients with CAD, mean age = 63.3 years (range, 36-80 years), were enrolled. Participants were randomly assigned to receive either glipizide (30 mg daily) or metformin (1.5 g daily) for 3 years. The primary end points were times to the composite of recurrent cardiovascular events, including death from a cardiovascular cause, death from any cause, nonfatal myocardial infarction, nonfatal stroke, or arterial revascularization.

resultsAt the end of study drug administration, both groups achieved a significant decrease in the level of glycated hemoglobin (7.1% in the glipizide group and 7.0% in the metformin group). At a median follow-up of 5.0 years, 91 participants had developed 103 primary end points. Intention-to-treat analysis showed an adjusted hazard ratio (HR) of 0.54 (95% CI 0.30-0.90; P = 0.026) for the composites of cardiovascular events among the patients that received metformin, compared with glipizide. The secondary end points and adverse events were not significantly different between the two groups.

conclusionsTreatment with metformin for 3 years substantially reduced major cardiovascular events in a median follow-up of 5.0 years compared with glipizide. Our results indicated a potential benefit of metformin therapy on cardiovascular outcomes in high-risk patients.

Indexed as

AdultAgedAged, 80 and overCoronary Artery DiseaseDiabetes Mellitus, Type 2Double-Blind MethodFemaleGlipizideHumansMaleMetforminMiddle AgedGlipizideMetformin

Identifiers

PMID23230096
PMCPMC3631843
OpenAlexW2141199290

What Socratic holds

Texttitle and abstract
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.