Evidence mapPaperPMID 40388602Full record

ArticleThe journals of gerontology. Series A, Biological sciences and medical sciences2025

Comparative Effectiveness of Metformin Versus Sulfonylureas on Exceptional Longevity in Women With Type 2 Diabetes: Target Trial Emulation.

Aladdin H Shadyab, Mark A Espeland, Andrew O Odegaard, JoAnn E Manson, Bernhard Haring, Karen C Johnson, Zhao Chen, Bowei Zhang, Andrea Z LaCroix

Abstract readComparative Study
In one paragraph

Article in The journals of gerontology. Series A, Biological sciences and medical sciences, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing 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

1 citing paper in PubMed.

  1. Review
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

9 authors.

Aladdin H ShadyabHerbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA.
Mark A EspelandDepartment of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.ORCID 0000-0002-3711-1949
Andrew O OdegaardDepartment of Epidemiology and Biostatistics, University of California Irvine, Irvine, California, USA.
JoAnn E MansonDivision of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Bernhard HaringDepartment of Medicine III, Saarland University, Homburg, Germany.
Karen C JohnsonDepartment of Preventive Medicine, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA.ORCID 0000-0002-3493-4077
Zhao ChenDepartment of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA.ORCID 0000-0002-5659-0447
Bowei ZhangHerbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA.ORCID 0009-0000-9686-0897
Andrea Z LaCroixHerbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA.

Funding

THE PURPOSE OF THIS MODIFICATION IS TO DE-OBLIGATE NHLBI FUNDING FROM THE WOMEN'S HEALTH INITIATIVE (WHI) - CLINICAL COORDINATING CENTER (CCC).75N92021D00001 · FRED HUTCHINSON CANCER CENTER · 2025 to 2025
$9.3M
WOMEN'S HEALTH INITIATIVE (WHI) REGIONAL CENTER (RC): TASK AREA A AND A275N92021D00002 · STATE UNIVERSITY OF NEW YORK AT BUFFALO · 2025 to 2025
$1.2M
WOMEN'S HEALTH INITIATIVE (WHI) REGIONAL CENTER (RC): TASK AREA A AND A275N92021D00004 · STANFORD UNIVERSITY · 2025 to 2025
$1.1M
WOMEN'S HEALTH INITIATIVE (WHI) REGIONAL CENTER (RC): TASK AREA A AND A275N92021D00005 · WAKE FOREST UNIVERSITY HEALTH SCIENCES · 2025 to 2025
$47k
WOMEN'S HEALTH INITIATIVE (WHI) REGIONAL CENTER (RC): TASK AREA A AND A275N92021D00003 · OHIO STATE UNIVERSITY · 2025 to 2025
$39k
NHLBI NIH HHS 75N92021D00001NHLBI NIH HHS 75N92021D00002NIH HHSWHI NIH HHS 75N92021D00003WHI NIH HHS 75N92021D00004WHI NIH HHS 75N92021D00005
6 · The paper itself

Abstract

backgroundThe association of metformin with mortality has been mixed, and no prior study has determined whether metformin initiation is associated with exceptional longevity, defined as survival to ages 90 and older.

methodsWe performed a new-user, active comparator cohort study using the target trial emulation framework among the Women's Health Initiative cohort to determine whether metformin versus sulfonylurea initiation was associated with exceptional longevity (survival to age 90). We identified participants ≥60 years with incident type 2 diabetes and no history of hypoglycemic agents or insulin prior to treatment initiation to perform intention-to-treat analyses. We used 1:1 propensity score matching on demographic characteristics, lifestyle behaviors, diabetes duration, comorbidities (hypertension, cardiovascular disease, chronic obstructive pulmonary disease, and cancer), body mass index, and concomitant medications to balance treatment groups on key confounders.

resultsAmong 438 propensity score-matched women with type 2 diabetes, the incidence rate of death before age 90 per 100 person-years in women initiating metformin monotherapy was 3.7 (95% CI: 3.1-4.4) compared with 5.0 (95% CI: 4.2-5.8) for sulfonylurea monotherapy. The adjusted risk of death before age 90 was 30% lower for initiation of metformin monotherapy versus sulfonylurea monotherapy (hazard ratio, 0.70; 95% CI: 0.56-0.88).

conclusionsIn this first target trial emulation of metformin and exceptional longevity, we found that metformin initiation increased exceptional longevity compared with sulfonylurea initiation among women with type 2 diabetes. Because this comparison was not made to placebo in a randomized controlled trial and given the observational design with potential for residual confounding, causality cannot be inferred.

Indexed as

Diabetes Mellitus, Type 2Hypoglycemic AgentsLongevityMetforminSulfonylurea CompoundsAgedAged, 80 and overCohort StudiesFemaleHumansMiddle AgedPropensity ScoreHypoglycemic AgentsMetforminSulfonylurea CompoundsGeroscienceGerotherapeuticHealthy agingMedication

Identifiers

PMID40388602
PMCPMC12223363

What Socratic holds

Texttitle and abstract
LicenceCC BY-NC-ND
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.