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Metformin and carotid intima-media thickness in never-smokers with type 1 diabetes: The REMOVAL trial

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@article{ed7ca025ded04515ab217fb2deeda59c,
title = "Metformin and carotid intima-media thickness in never-smokers with type 1 diabetes: The REMOVAL trial",
abstract = "AIM: To determine whether metformin's effects on carotid artery intima-media thickness (cIMT) in type 1 diabetes differ according to smoking status.METHODS: Regression model effect estimates for the effect of metformin versus placebo (double-blind) on carotid IMT were calculated as a subgroup analysis of the REMOVAL trial.RESULTS: In 428 randomized participants (227 never-smokers, 201 ever-smokers), averaged mean carotid IMT progression (per year) was reduced by metformin versus placebo in never-smokers (-0.012 mm, 95% CI -0.021 to -0.002; p = .0137) but not in ever-smokers (0.003 mm, 95% CI -0.008 to 0.014; p = .5767); and similarly in non-current smokers (-0.008 mm, 95% CI -0.015 to -0.00001; p = .0497) but not in current smokers (0.013 mm, 95% CI -0.007 to 0.032; p = .1887). Three-way interaction terms (treatment*time*smoking status) were significant for never versus ever smoking (p = .0373, prespecified) and non-current versus current smoking (p = .0496, exploratory). Averaged maximal carotid IMT progression (per year) was reduced by metformin versus placebo in never-smokers (-0.020 mm, 95% CI -0.034 to -0.006; p = .0067) but not in ever-smokers (-0.006 mm, 95% CI -0.020 to 0.008; p = .4067), although this analysis was not supported by a significant three-way interaction term.CONCLUSIONS: This subgroup analysis of the REMOVAL trial provides additional support for a potentially wider role of adjunct metformin therapy in cardiovascular risk management in type 1 diabetes, particularly for individuals who have never smoked cigarettes.",
keywords = "cardiovascular disease, diabetes complications, metformin, type 1 diabetes",
author = "Timmons, {Joseph G} and Nicola Greenlaw and Boyle, {James G} and Nish Chaturvedi and Ian Ford and Brouwers, {Martijn C G J} and Therese Tillin and Irene Hramiak and Hughes, {Alun D} and Jenkins, {Alicia J} and Klein, {Barbara E K} and Ron Klein and Ooi, {Teik C} and Peter Rossing and Stehouwer, {Coen D A} and Naveed Sattar and Colhoun, {Helen M} and Petrie, {John R} and {REMOVAL Study Group}",
note = "{\textcopyright} 2021 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.",
year = "2021",
month = jun,
doi = "10.1111/dom.14350",
language = "English",
volume = "23",
pages = "1371--1378",
journal = "Diabetes, Obesity and Metabolism",
issn = "1462-8902",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "6",

}

RIS

TY - JOUR

T1 - Metformin and carotid intima-media thickness in never-smokers with type 1 diabetes

T2 - The REMOVAL trial

AU - Timmons, Joseph G

AU - Greenlaw, Nicola

AU - Boyle, James G

AU - Chaturvedi, Nish

AU - Ford, Ian

AU - Brouwers, Martijn C G J

AU - Tillin, Therese

AU - Hramiak, Irene

AU - Hughes, Alun D

AU - Jenkins, Alicia J

AU - Klein, Barbara E K

AU - Klein, Ron

AU - Ooi, Teik C

AU - Rossing, Peter

AU - Stehouwer, Coen D A

AU - Sattar, Naveed

AU - Colhoun, Helen M

AU - Petrie, John R

AU - REMOVAL Study Group

N1 - © 2021 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

PY - 2021/6

Y1 - 2021/6

N2 - AIM: To determine whether metformin's effects on carotid artery intima-media thickness (cIMT) in type 1 diabetes differ according to smoking status.METHODS: Regression model effect estimates for the effect of metformin versus placebo (double-blind) on carotid IMT were calculated as a subgroup analysis of the REMOVAL trial.RESULTS: In 428 randomized participants (227 never-smokers, 201 ever-smokers), averaged mean carotid IMT progression (per year) was reduced by metformin versus placebo in never-smokers (-0.012 mm, 95% CI -0.021 to -0.002; p = .0137) but not in ever-smokers (0.003 mm, 95% CI -0.008 to 0.014; p = .5767); and similarly in non-current smokers (-0.008 mm, 95% CI -0.015 to -0.00001; p = .0497) but not in current smokers (0.013 mm, 95% CI -0.007 to 0.032; p = .1887). Three-way interaction terms (treatment*time*smoking status) were significant for never versus ever smoking (p = .0373, prespecified) and non-current versus current smoking (p = .0496, exploratory). Averaged maximal carotid IMT progression (per year) was reduced by metformin versus placebo in never-smokers (-0.020 mm, 95% CI -0.034 to -0.006; p = .0067) but not in ever-smokers (-0.006 mm, 95% CI -0.020 to 0.008; p = .4067), although this analysis was not supported by a significant three-way interaction term.CONCLUSIONS: This subgroup analysis of the REMOVAL trial provides additional support for a potentially wider role of adjunct metformin therapy in cardiovascular risk management in type 1 diabetes, particularly for individuals who have never smoked cigarettes.

AB - AIM: To determine whether metformin's effects on carotid artery intima-media thickness (cIMT) in type 1 diabetes differ according to smoking status.METHODS: Regression model effect estimates for the effect of metformin versus placebo (double-blind) on carotid IMT were calculated as a subgroup analysis of the REMOVAL trial.RESULTS: In 428 randomized participants (227 never-smokers, 201 ever-smokers), averaged mean carotid IMT progression (per year) was reduced by metformin versus placebo in never-smokers (-0.012 mm, 95% CI -0.021 to -0.002; p = .0137) but not in ever-smokers (0.003 mm, 95% CI -0.008 to 0.014; p = .5767); and similarly in non-current smokers (-0.008 mm, 95% CI -0.015 to -0.00001; p = .0497) but not in current smokers (0.013 mm, 95% CI -0.007 to 0.032; p = .1887). Three-way interaction terms (treatment*time*smoking status) were significant for never versus ever smoking (p = .0373, prespecified) and non-current versus current smoking (p = .0496, exploratory). Averaged maximal carotid IMT progression (per year) was reduced by metformin versus placebo in never-smokers (-0.020 mm, 95% CI -0.034 to -0.006; p = .0067) but not in ever-smokers (-0.006 mm, 95% CI -0.020 to 0.008; p = .4067), although this analysis was not supported by a significant three-way interaction term.CONCLUSIONS: This subgroup analysis of the REMOVAL trial provides additional support for a potentially wider role of adjunct metformin therapy in cardiovascular risk management in type 1 diabetes, particularly for individuals who have never smoked cigarettes.

KW - cardiovascular disease

KW - diabetes complications

KW - metformin

KW - type 1 diabetes

UR - http://www.scopus.com/inward/record.url?scp=85102173556&partnerID=8YFLogxK

U2 - 10.1111/dom.14350

DO - 10.1111/dom.14350

M3 - Journal article

C2 - 33591613

VL - 23

SP - 1371

EP - 1378

JO - Diabetes, Obesity and Metabolism

JF - Diabetes, Obesity and Metabolism

SN - 1462-8902

IS - 6

ER -

ID: 64863600