Evidence map›Paper›PMID 28676291›Full record

ArticleJournal of the American Medical Directors Association2017

Metformin Safety Warnings and Diabetes Drug Prescribing Patterns for Older Nursing Home Residents.

Andrew R Zullo, David D Dore, Roee Gutman, Vincent Mor, Carlos A Alvarez, Robert J Smith

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Medical Directors Association, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
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.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Article
  2. Article
  3. Comparative safety of sulfonylureas among U.S. nursing home residents.Journal of the American Geriatrics Society · 2023
    Article
  4. Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Andrew R ZulloDepartment of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI. Electronic address: andrew_zullo@brown.edu.
David D DoreDepartment of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI; Optum Epidemiology, Boston, MA.
Roee GutmanDepartment of Biostatistics, School of Public Health, Brown University, Providence, RI.
Vincent MorDepartment of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI.
Carlos A AlvarezDepartment of Pharmacy Practice, Texas Tech University Health Sciences Center, Dallas, TX.
Robert J SmithDepartment of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI; Department of Medicine, Alpert Medical School, Brown University, Providence, RI.

Funding

Develop Patient Centered Outcomes Scholars for Comparative Effectiveness ResearchK12HS022998 · AHRQ · BROWN UNIVERSITY · PI TRIKALINOS, THOMAS · 2014 to 2018
$3.4M
Safety and Effectiveness of Metformin Therapy in Patients with Type 2 Diabetes anK08DK101602 · NIDDK · TEXAS TECH UNIVERSITY HEALTH SCIS CENTER · PI ALVAREZ, CARLOS A · 2014 to 2017
$536k
AHRQ HHS K12 HS022998NIDDK NIH HHS K08 DK101602
6 · The paper itself

Abstract

objectiveDiabetes mellitus is common in US nursing homes (NHs), and the mainstay treatment, metformin, has US Food and Drug Administration (FDA) boxed warnings indicating safety concerns in those with advanced age, heart failure, or renal disease. Little is known about treatment selection in this setting, especially for metformin. We quantified the determinants of initiating sulfonylureas over metformin with the aim of understanding the impact of FDA-labeled boxed warnings in older NH residents. DESIGN AND

settingNational retrospective cohort in US NHs.

participantsLong-stay NH residents age ≥65 years who initiated metformin or sulfonylurea monotherapy following a period of ≥6 months with no glucose-lowering treatment use between 2008 and 2010 (n = 7295). MEASUREMENTS: Measures of patient characteristics were obtained from linked national Minimum Data Set assessments; Online Survey, Certification and Reporting (OSCAR) records; and Medicare claims. Odds ratios (ORs) comparing patient characteristics and treatment initiation were estimated using univariable and multivariable multilevel logistic regression models with NH random intercepts.

resultsOf the 7295 residents in the study population, 3066 (42%) initiated metformin and 4229 (58%) initiated a sulfonylurea. In multivariable analysis, several factors were associated with sulfonylurea initiation over metformin initiation, including heart failure (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.1-1.4) and renal disease (OR 2.1, 95% CI 1.7-2.5). Compared with those aged 65 to <75 years, residents 75 to <85 (OR 1.3, 95% CI 1.2-1.5), 85 to <95 (OR 2.0, 95% CI 1.7-2.3), and ≥95 (OR 4.3, 95% CI 3.2-5.8) years were more likely to initiate sulfonylureas over metformin.

conclusionsIn response to FDA warnings, providers initiated NH residents on a drug class with a known, common adverse event (hypoglycemia with sulfonylureas) over one with tenuous evidence of a rare adverse event (lactic acidosis with metformin).

Indexed as

Drug LabelingNursing HomesPractice Patterns, Physicians'Prescription DrugsDiabetes MellitusHumansHypoglycemic AgentsMetforminUnited StatesUnited States Food and Drug AdministrationHypoglycemic AgentsMetforminPrescription Drugscontraindicationsdiabetesdrug prescribingNursing hometreatment choice variationUS Food and Drug Administration

Identifiers

PMID28676291
PMCPMC5612829

What Socratic holds

Texttitle and abstract
LicenceTDM
Read underepoch 390

Registered trials

None linked

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.