14 Apr Could Preoperative Metformin Reduce Morbidity and Mortality in Diabetics?
MedicalResearch.com Interview with:
Katherine Moll Reitz, MD
General Surgery Resident
University of Pittsburgh
MedicalResearch.com: What is the background for this study?
Response: Surgical interventions both save lives and improve the quality of those lives each day. However, these same interventions and the recovery thereafter are a major physiologic stressor. Younger, more resilient patients tend to recover faster, with fewer postoperative complications when compared to older, frailer patients undergoing the same surgical treatments. Therefore, investigators at University of Pittsburgh and UPMC have begun focusing on prehabilitation in order to optimize at risk patients preoperatively. Just as an athlete would train for an upcoming event, prehabilitation (including smoking cessation, healthy eating, and physical activity increases) prepares or trains patients for their surgical intervention and can improve their postoperative outcomes.
Currently, there is no medication available to aid in this training process, improving patients’ response to the physiologic stress of surgery. Therefore, we are interested in exploring potential safe, well tolerated medical therapies which can optimize patients as pharmacologic prehabilitation.
MedicalResearch.com: What are the main findings?
Response: Recently, metformin has been shown to have powerful anti-inflammatory and anti-aging properties, making this first line treatment for type 2 diabetes an excellent candidate for preoperative training and prehabilitation.
We found that among over 5,000 diabetics undergoing major surgical interventions, preoperative metformin exposure was associated with a nearly 25% reduction in the risk of 90 day mortality and 15% reduction in 90 day readmission.
MedicalResearch.com: What should readers take away from your report?
Response: After controlling for differences between treatment groups, metformin exposure was associated with a major reduction in both 90-day morbidity and mortality in diabetics. If we conservatively estimate that 20 million major surgeries occur annually in the United States, our data would suggest metformin may help to reduce readmissions for 200,000 Americans and prolong the life 10,000 each year!
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Our findings have been the impetus for a randomized, embedded, multifactorial, adaptative platform (REMAP) trial to continually evaluate the effectiveness of perioperative therapies within the UPMC healthcare system which we named Strategies to Promote ResiliencY (SPRY) (ClinicalTrials.gov; NCT03861767).
Metformin is the first of many future placebo controlled trials evaluating perioperative effectiveness of therapies hypothesized to improve postoperative outcomes in high-risk, older adults undergoing a major surgical intervention.
We have nothing to disclose.
Reitz KM, Marroquin OC, Zenati MS, et al. Association Between Preoperative Metformin Exposure and Postoperative Outcomes in Adults With Type 2 Diabetes. JAMA Surg. Published online April 08, 2020. doi:10.1001/jamasurg.2020.0416
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