Observational studyCardiovascular diabetology2025

The impact of metformin on kidney disease progression and mortality in diabetic patients using SGLT2 inhibitors: a real-world cohort study.

Timna Agur et al.PubMed ↗Full text ↗Publisher ↗

Metformin and SGLT2 inhibitorslooks good hereFewer deaths, lower composite kidney outcomes, fewer hospitalization.Correlation only, not a test of it.

What moved togetherboth groups pooled, not the treatment’s effect

Correlation, not cause

Metformin and SGLT2 inhibitors went with fewer deaths

−26%−36% to −16%

metformin and SGLT2 inhibitors vs SGLT2 inhibitors alone

Bigger than 7 in 10 for all-cause mortality

As reported

HR 0.74, 95% CI 0.64–0.84 · the paper's word: all-cause mortality

Correlation, not cause

Metformin and SGLT2 inhibitors went with lower composite kidney outcomes

−35%−52% to −13%

metformin and SGLT2 inhibitors vs SGLT2 inhibitors alone

Bigger than 7 in 10 on the map

As reported

HR 0.65, 95% CI 0.48–0.87

Correlation, not cause

Metformin and SGLT2 inhibitors went with lower composite kidney outcomes

−33%−50% to −10%

metformin and SGLT2 inhibitors vs SGLT2 inhibitors alone

Bigger than 8 in 10 for all-cause mortality

As reported

HR 0.67, 95% CI 0.50–0.90

+3 more in the walkthrough ↓

Who was studied, and how

45,545people with type 2 diabetes, in this paper

Already taking metformin and SGLT2 inhibitors, or nottheir own situation, not assigned

on metformin and SGLT2 inhibitors

SGLT2 inhibitors alone

Metformin and SGLT2 inhibitors went with fewer deaths−26%

Metformin and SGLT2 inhibitors went with lower composite kidney outcomes−35%

Metformin and SGLT2 inhibitors went with fewer hospitalization−7%

correlation, not a test

the abstract, start to end

… reduced risk of all-cause mortality (aHR 0.74, 95% CI 0.64-0.84), and composite kidney outcomes (aHR 0.65 95% CI 0.48-0.87) even after accounting for mortality as a competing risk (aHR 0.67; 95% CI 0.5-0.9).

… reduced risks of hospitalization (aHR 0.93 95% CI 0.87-0.99), severe acute kidney injury events (aHR 0.72 95% CI 0.54-0.96) and metabolic acidosis events (aHR 0.58 95% CI 0.4-0.83), compared with …

← favours treatmentfavours comparator →

could be chance

All-cause mortalitymetformin and SGLT2 inhibitors vs SGLT2 inhibitors alone

HR 0.740.64–0.84

Composite kidney outcomesmetformin and SGLT2 inhibitors vs SGLT2 inhibitors alone

HR 0.650.48–0.87

Composite kidney outcomes (accounting for mortality as a competing risk)metformin and SGLT2 inhibitors vs SGLT2 inhibitors alone

HR 0.670.50–0.90

Hospitalizationmetformin and SGLT2 inhibitors vs SGLT2 inhibitors alone

HR 0.930.87–0.99

Severe acute kidney injury eventsmetformin and SGLT2 inhibitors vs SGLT2 inhibitors alone

HR 0.720.54–0.96

Metabolic acidosis eventsmetformin and SGLT2 inhibitors vs SGLT2 inhibitors alone

HR 0.580.40–0.83

MetforminSGLT2 inhibitorsAll-cause mortalityKidney outcomesAdverse events & safety

1 / 4

12 papers cite it

2025

2026

this papercites it

The impact of metformin on kidney disease progression and mortality in diabetic patients using SGLT2 inhibitors: a real-world cohort study.

What moved togetherboth groups pooled, not the treatment’s effect

Metformin and SGLT2 inhibitors went with fewer deaths

Metformin and SGLT2 inhibitors went with lower composite kidney outcomes

Metformin and SGLT2 inhibitors went with lower composite kidney outcomes

Who was studied, and how

Six numbers in the abstract

Where each one falls

Where it lands on the map

12 papers cite it