OBJECTIVE To compare the safety of metformin vs sulfonylureas in patients with type 2 diabetes by chronic kidney disease (CKD) stage. PATIENTS AND METHODS This retrospective cohort study included adults in Manitoba, Canada, with type 2 diabetes, an incident monotherapy prescription for metformin or a sulfonylurea, and a serum creatinine measurement from April 1, 2006, to March 31, 2017. Patients were stratified by estimated glomerular filtration rate (eGFR) into the following groups: eGFR of 90 or greater, 60 to 89, 45 to 59, 30 to 44, or less than 30 mL/min/1.73 m2. Outcomes included all-cause mortality, cardiovascular events, and major hypoglycemic episodes. Baseline characteristics were used to calculate propensity scores and perform inverse probability of treatment weights analysis, and eGFR group was examined as an effect modifier for each outcome. RESULTS The cohort consisted of 21,996 individuals (19,990 metformin users and 2006 sulfonylurea users). Metformin use was associated with lower risk for all-cause mortality (hazard ratio [HR], 0.48; 95% CI, 0.40-0.58; P<.001), cardiovascular events (HR, 0.67; 95% CI, 0.52-0.86; P=.002), and major hypoglycemic episodes (HR, 0.14; 95% CI, 0.09-0.20; P<.001) when compared with sulfonylureas. CKD was a significant effect modifier for all-cause mortality (P=.002), but not for cardiovascular events or major hypoglycemic episodes. CONCLUSION Sulfonylurea monotherapy is associated with higher risk for all-cause mortality, major hypoglycemic episodes, and cardiovascular events compared with metformin. Although the presence of CKD attenuated the mortality benefit, metformin may be a safer alternative to sulfonylureas in patients with CKD.

中文翻译：

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二甲双胍和磺脲类药物在2型糖尿病和慢性肾脏病患者中的安全性比较：一项回顾性队列研究。

目的比较二甲双胍和磺脲类药物在慢性肾脏病（CKD）分期的2型糖尿病患者中的安全性。患者与方法这项回顾性队列研究包括2006年4月1日至2017年3月31日在加拿大马尼托巴省患有2型糖尿病的成人，二甲双胍或磺酰脲的单药治疗处方以及血清肌酐的测定。估计的肾小球滤过率（eGFR）分为以下几类：eGFR为90或更高，60至89、45至59、30至44或小于30 mL / min / 1.73 m2。结果包括全因死亡率，心血管事件和主要的降血糖事件。使用基线特征来计算倾向得分并进行治疗权重分析的逆概率，eGFR组作为每个结局的效果调节剂进行了检查。结果该队列包括21,996个人（19,990二甲双胍使用者和2006磺酰脲使用者）。使用二甲双胍与全因死亡率较低（危险比[HR]为0.48； 95％CI为0.40-0.58； P <.001），心血管事件（HR为0.67； 95％CI为0.52-0.86；与磺酰脲类药物相比，P = .002）和主要的降血糖事件（HR，0.14； 95％CI，0.09-0.20； P <.001）。CKD是全因死亡率的重要效应调节剂（P = .002），但对于心血管事件或主要的降血糖事件却不是。结论与二甲双胍相比，磺脲类药物单一疗法与全因死亡率，主要降血糖事件和心血管事件的高风险相关。尽管CKD的存在削弱了死亡率，