Evidence map›Paper›PMID 35112189›Full record

ArticleActa diabetologica2022

Metformin versus sulphonylureas for new onset atrial fibrillation and stroke in type 2 diabetes mellitus: a population-based study.

Jiandong Zhou, Guoming Zhang, Carlin Chang, Oscar Hou In Chou, Sharen Lee, Keith Sai Kit Leung, Wing Tak Wong, Tong Liu, Abraham Ka Chung Wai, Shuk Han Cheng and 2 more

Abstract read
PubMed Publisher
In one paragraph

Article in Acta diabetologica, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 1 pooled it
4.9field-weighted citation impact, top 4% 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.

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

23 citing papers in PubMed, 1 synthesis or guideline pooled it, 37 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Article
  4. Metformin Beyond Glycemic Control: Cardiovascular Protection and Diabetes Prevention.Journal of cardiovascular development and disease · 2026
    Review
  5. Review
  6. Review
  7. Article
  8. Article
  9. Article
  10. Article
  11. Review
  12. Article
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  14. Review
  15. Article
  16. Article
  17. Dysglycemia and arrhythmias.World journal of diabetes · 2023
    Review
  18. Article
  19. Observational
  20. 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

12 authors at 9 institutions in 3 countries.

Jiandong Zhou *Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Guoming Zhang *Emergency Department, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China.
Carlin ChangDepartment of Medicine, University of Hong Kong, Pokfulam, Hong Kong, China.
Oscar Hou In ChouDepartment of Medicine, University of Hong Kong, Pokfulam, Hong Kong, China.ORCID http://orcid.org/0000-0001-7058-4708
Sharen LeeDiabetes Research Unit, Cardiovascular Analytics Group, UK-China Collaboration, Hong Kong, China.
Keith Sai Kit LeungAston Medical School, Aston University, Birmingham, UK.
Wing Tak WongSchool of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China.
Tong LiuTianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
Abraham Ka Chung WaiEmergency Medicine Unit, Li Ka Shing, Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Shuk Han ChengSchool of Biomedical Sciences, City University of Hong Kong, Hong Kong, China.
Qingpeng ZhangSchool of Data Science, City University of Hong Kong, Kowloon City, Hong Kong, China. qingpeng.zhang@cityu.edu.hk.
Gary TseTianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China. gary.tse@kmms.ac.uk.
City University of Hong Kong · HKDiabetes UK · GBUniversity of Hong Kong · HKAston University · GBChinese University of Hong Kong · HKMedway School of Pharmacy · GBSecond Hospital of Tianjin Medical University · CNUniversity of Oxford · GBXiamen University · CN

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsTo gain insights on the cardiovascular effects of metformin and sulphonylurea, the present study compares the rates of incident atrial fibrillation, stroke, cardiovascular mortality and all-cause mortality between metformin and sulphonylurea users in type 2 diabetes mellitus.

methodsThis was a retrospective population-based cohort study of type 2 diabetes mellitus patients receiving either sulphonylurea or metformin monotherapy between January 1, 2000, and December 31, 2019. The primary outcome was new-onset AF or stroke. Secondary outcomes were cardiovascular, non-cardiovascular and all-cause mortality. Propensity score matching (1:2 ratio) between sulphonylurea and metformin users was performed, based on demographics, CHA-DS-VASc score, past comorbidities and medication use. Cox regression was used to identify significant risk factors. Competing risk analysis was conducted using cause-specific and subdistribution hazard models. Sensitivity analyses using propensity score stratification, high-dimensional propensity score and inverse probability of treatment weighting were conducted. Subgroup analyses were conducted for age and gender in the matched cohort.

resultsA total of 36,228 sulphonylurea users and 72,456 metformin users were included in the propensity score-matched cohort. Multivariable Cox regression showed that sulphonylurea users had higher risks of incident AF (hazard ratio [HR]: 2.89, 95% confidence interval [CI]: 2.75-3.77; P < 0.0001), stroke (HR: 3.23, 95% CI: 3.01-3.45; P < 0.0001), cardiovascular mortality (HR: 3.60, 95% CI: 2.62-4.81; P < 0.0001) and all-cause mortality (HR: 4.35, 95% CI: 3.16-4.75; P < 0.0001) compared to metformin users. Similarly, significant results were observed using cause-specific and subdistribution hazard models. Sensitivity analysis using techniques based on the propensity score also yielded similar results.

conclusionsSulphonylurea use was associated with higher risks of incident AF, stroke, cardiovascular mortality and all-cause mortality compared to metformin. Males and patients older than 65 years with sulphonylurea use were exposed to the highest risks.

Indexed as

Atrial FibrillationDiabetes Mellitus, Type 2MetforminStrokeCohort StudiesHumansHypoglycemic AgentsMaleRetrospective StudiesSulfonylurea CompoundsHypoglycemic AgentsMetforminSulfonylurea CompoundsAtrial fibrillationBig dataDiabetesMetforminStrokeSulphonylurea

Identifiers

PMID35112189
OpenAlexW4225565608

What Socratic holds

Texttitle and abstract
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.