Metformin is associated with reduced risk of mortality and morbidity in burn patients compared to insulin
The standard of care for burned patients experiencing hyperglycemia associated with the hypermetabolic response is insulin therapy. Insulin treatment predisposes burn patients to hypoglycemia, which increases morbidity and mortality. Metformin has been suggested as an alternative to insulin therapy...
Gespeichert in:
| Veröffentlicht in: | Burns 2024-09, Vol.50 (7), p.1779-1789 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1789 |
|---|---|
| container_issue | 7 |
| container_start_page | 1779 |
| container_title | Burns |
| container_volume | 50 |
| creator | Hallman, Taylor G. Golovko, Georgiy Song, Juquan Palackic, Alen Wolf, Steven E. El Ayadi, Amina |
| description | The standard of care for burned patients experiencing hyperglycemia associated with the hypermetabolic response is insulin therapy. Insulin treatment predisposes burn patients to hypoglycemia, which increases morbidity and mortality. Metformin has been suggested as an alternative to insulin therapy for glycemic control in burn patients given its safety profile, but further research is warranted. This study investigated whether metformin use in burn patients is associated with improved glycemic control and morbidity/mortality outcomes compared to insulin use alone.
Using the TriNetX database, we conducted a retrospective study of burned patients who were administered insulin, metformin, or both within one week of injury. Demographic, comorbidity, and burn severity information were collected. Patients were categorized by treatment type, propensity score-matched, and compared for the following outcomes within 3 months: hyperglycemia, hypoglycemia, sepsis, lactic acidosis, and death. Statistical significance was set a priori at p ≤ 0.05.
The insulin cohort was at increased risk for all outcomes (all p |
| doi_str_mv | 10.1016/j.burns.2024.05.015 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3077992572</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0305417924001670</els_id><sourcerecordid>3077992572</sourcerecordid><originalsourceid>FETCH-LOGICAL-c239t-d9143f47235179202b1b87f5010803a9c0a79b0fe1a633ff627db081128fda443</originalsourceid><addsrcrecordid>eNp9kEtPxCAUhYnROOPoLzAxLN20Xko7LQsXxvhKNG50TSiPyNiWEahm_r3UGV3Khhw45z4-hE4J5ATI8mKVt6MfQl5AUeZQ5UCqPTQnTc0yUgLbR3OgUGUlqdkMHYWwgnSqBg7RjDasSc9sjuyTjsb53g7YBixCcNKKqBX-svENe61GmYS34R07g3vno-hs3GAxqEm1Vk0qpadZ8FpEq4cYsHT9WqQ0ji59hrGzwzE6MKIL-mR3L9Dr7c3L9X32-Hz3cH31mMmCspgpRkpqyrqgVZow7daStqlNBQQaoIJJEDVrwWgilpQasyxq1UJDSNEYJcqSLtD5tu7au49Rh8h7G6TuOjFoNwZOoU6bF1XqsEB0a5XeheC14Wtve-E3nACfGPMV_2HMJ8YcKp4Yp9TZrsHY9lr9ZX6hJsPl1qDTmp9Wex5kwpJAWq9l5MrZfxt8A0Kij0A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3077992572</pqid></control><display><type>article</type><title>Metformin is associated with reduced risk of mortality and morbidity in burn patients compared to insulin</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Hallman, Taylor G. ; Golovko, Georgiy ; Song, Juquan ; Palackic, Alen ; Wolf, Steven E. ; El Ayadi, Amina</creator><creatorcontrib>Hallman, Taylor G. ; Golovko, Georgiy ; Song, Juquan ; Palackic, Alen ; Wolf, Steven E. ; El Ayadi, Amina</creatorcontrib><description>The standard of care for burned patients experiencing hyperglycemia associated with the hypermetabolic response is insulin therapy. Insulin treatment predisposes burn patients to hypoglycemia, which increases morbidity and mortality. Metformin has been suggested as an alternative to insulin therapy for glycemic control in burn patients given its safety profile, but further research is warranted. This study investigated whether metformin use in burn patients is associated with improved glycemic control and morbidity/mortality outcomes compared to insulin use alone.
Using the TriNetX database, we conducted a retrospective study of burned patients who were administered insulin, metformin, or both within one week of injury. Demographic, comorbidity, and burn severity information were collected. Patients were categorized by treatment type, propensity score-matched, and compared for the following outcomes within 3 months: hyperglycemia, hypoglycemia, sepsis, lactic acidosis, and death. Statistical significance was set a priori at p ≤ 0.05.
The insulin cohort was at increased risk for all outcomes (all p < 0.0001) compared to the metformin cohort, and an increased risk for sepsis, lactic acidosis, and death (all p ≤ 0.0002) compared to the insulin/metformin combination cohort. When compared to the metformin cohort, the combination cohort was at increased risk for all outcomes (all p ≤ 0.0107) except death.
Treatment with metformin after burn is associated with a reduced risk of morbidity and mortality compared to insulin. The combination of insulin and metformin is no more effective in reducing the risk of hyperglycemia and hypoglycemia than insulin alone but is less effective than metformin alone.
•Uncontrolled hyperglycemia in burned patients increases morbidity and mortality.•Insulin predisposes to hypoglycemia, which increases mortality in burned patients.•Morbidity and mortality are reduced in patients treated with metformin vs. insulin.•Metformin may serve as a viable alternative to insulin in these patients.</description><identifier>ISSN: 0305-4179</identifier><identifier>ISSN: 1879-1409</identifier><identifier>EISSN: 1879-1409</identifier><identifier>DOI: 10.1016/j.burns.2024.05.015</identifier><identifier>PMID: 38981799</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Acidosis, Lactic - chemically induced ; Acidosis, Lactic - epidemiology ; Adult ; Aged ; Burn ; Burns - complications ; Burns - drug therapy ; Burns - mortality ; Drug Therapy, Combination ; Female ; Glycemic Control - methods ; Humans ; Hyperglycemia ; Hyperglycemia - drug therapy ; Hypoglycemia ; Hypoglycemia - chemically induced ; Hypoglycemia - epidemiology ; Hypoglycemic Agents - therapeutic use ; Insulin ; Insulin - therapeutic use ; Male ; Metformin ; Metformin - therapeutic use ; Middle Aged ; Mortality ; Propensity Score ; Retrospective Studies ; Sepsis - drug therapy ; Sepsis - mortality</subject><ispartof>Burns, 2024-09, Vol.50 (7), p.1779-1789</ispartof><rights>2024 Elsevier Ltd and International Society of Burns Injuries</rights><rights>Copyright © 2024 Elsevier Ltd and International Society of Burns Injuries. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c239t-d9143f47235179202b1b87f5010803a9c0a79b0fe1a633ff627db081128fda443</cites><orcidid>0000-0002-3657-0633 ; 0000-0003-4609-2767</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.burns.2024.05.015$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38981799$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hallman, Taylor G.</creatorcontrib><creatorcontrib>Golovko, Georgiy</creatorcontrib><creatorcontrib>Song, Juquan</creatorcontrib><creatorcontrib>Palackic, Alen</creatorcontrib><creatorcontrib>Wolf, Steven E.</creatorcontrib><creatorcontrib>El Ayadi, Amina</creatorcontrib><title>Metformin is associated with reduced risk of mortality and morbidity in burn patients compared to insulin</title><title>Burns</title><addtitle>Burns</addtitle><description>The standard of care for burned patients experiencing hyperglycemia associated with the hypermetabolic response is insulin therapy. Insulin treatment predisposes burn patients to hypoglycemia, which increases morbidity and mortality. Metformin has been suggested as an alternative to insulin therapy for glycemic control in burn patients given its safety profile, but further research is warranted. This study investigated whether metformin use in burn patients is associated with improved glycemic control and morbidity/mortality outcomes compared to insulin use alone.
Using the TriNetX database, we conducted a retrospective study of burned patients who were administered insulin, metformin, or both within one week of injury. Demographic, comorbidity, and burn severity information were collected. Patients were categorized by treatment type, propensity score-matched, and compared for the following outcomes within 3 months: hyperglycemia, hypoglycemia, sepsis, lactic acidosis, and death. Statistical significance was set a priori at p ≤ 0.05.
The insulin cohort was at increased risk for all outcomes (all p < 0.0001) compared to the metformin cohort, and an increased risk for sepsis, lactic acidosis, and death (all p ≤ 0.0002) compared to the insulin/metformin combination cohort. When compared to the metformin cohort, the combination cohort was at increased risk for all outcomes (all p ≤ 0.0107) except death.
Treatment with metformin after burn is associated with a reduced risk of morbidity and mortality compared to insulin. The combination of insulin and metformin is no more effective in reducing the risk of hyperglycemia and hypoglycemia than insulin alone but is less effective than metformin alone.
•Uncontrolled hyperglycemia in burned patients increases morbidity and mortality.•Insulin predisposes to hypoglycemia, which increases mortality in burned patients.•Morbidity and mortality are reduced in patients treated with metformin vs. insulin.•Metformin may serve as a viable alternative to insulin in these patients.</description><subject>Acidosis, Lactic - chemically induced</subject><subject>Acidosis, Lactic - epidemiology</subject><subject>Adult</subject><subject>Aged</subject><subject>Burn</subject><subject>Burns - complications</subject><subject>Burns - drug therapy</subject><subject>Burns - mortality</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Glycemic Control - methods</subject><subject>Humans</subject><subject>Hyperglycemia</subject><subject>Hyperglycemia - drug therapy</subject><subject>Hypoglycemia</subject><subject>Hypoglycemia - chemically induced</subject><subject>Hypoglycemia - epidemiology</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Insulin</subject><subject>Insulin - therapeutic use</subject><subject>Male</subject><subject>Metformin</subject><subject>Metformin - therapeutic use</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Propensity Score</subject><subject>Retrospective Studies</subject><subject>Sepsis - drug therapy</subject><subject>Sepsis - mortality</subject><issn>0305-4179</issn><issn>1879-1409</issn><issn>1879-1409</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtPxCAUhYnROOPoLzAxLN20Xko7LQsXxvhKNG50TSiPyNiWEahm_r3UGV3Khhw45z4-hE4J5ATI8mKVt6MfQl5AUeZQ5UCqPTQnTc0yUgLbR3OgUGUlqdkMHYWwgnSqBg7RjDasSc9sjuyTjsb53g7YBixCcNKKqBX-svENe61GmYS34R07g3vno-hs3GAxqEm1Vk0qpadZ8FpEq4cYsHT9WqQ0ji59hrGzwzE6MKIL-mR3L9Dr7c3L9X32-Hz3cH31mMmCspgpRkpqyrqgVZow7daStqlNBQQaoIJJEDVrwWgilpQasyxq1UJDSNEYJcqSLtD5tu7au49Rh8h7G6TuOjFoNwZOoU6bF1XqsEB0a5XeheC14Wtve-E3nACfGPMV_2HMJ8YcKp4Yp9TZrsHY9lr9ZX6hJsPl1qDTmp9Wex5kwpJAWq9l5MrZfxt8A0Kij0A</recordid><startdate>202409</startdate><enddate>202409</enddate><creator>Hallman, Taylor G.</creator><creator>Golovko, Georgiy</creator><creator>Song, Juquan</creator><creator>Palackic, Alen</creator><creator>Wolf, Steven E.</creator><creator>El Ayadi, Amina</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3657-0633</orcidid><orcidid>https://orcid.org/0000-0003-4609-2767</orcidid></search><sort><creationdate>202409</creationdate><title>Metformin is associated with reduced risk of mortality and morbidity in burn patients compared to insulin</title><author>Hallman, Taylor G. ; Golovko, Georgiy ; Song, Juquan ; Palackic, Alen ; Wolf, Steven E. ; El Ayadi, Amina</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c239t-d9143f47235179202b1b87f5010803a9c0a79b0fe1a633ff627db081128fda443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Acidosis, Lactic - chemically induced</topic><topic>Acidosis, Lactic - epidemiology</topic><topic>Adult</topic><topic>Aged</topic><topic>Burn</topic><topic>Burns - complications</topic><topic>Burns - drug therapy</topic><topic>Burns - mortality</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>Glycemic Control - methods</topic><topic>Humans</topic><topic>Hyperglycemia</topic><topic>Hyperglycemia - drug therapy</topic><topic>Hypoglycemia</topic><topic>Hypoglycemia - chemically induced</topic><topic>Hypoglycemia - epidemiology</topic><topic>Hypoglycemic Agents - therapeutic use</topic><topic>Insulin</topic><topic>Insulin - therapeutic use</topic><topic>Male</topic><topic>Metformin</topic><topic>Metformin - therapeutic use</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Propensity Score</topic><topic>Retrospective Studies</topic><topic>Sepsis - drug therapy</topic><topic>Sepsis - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hallman, Taylor G.</creatorcontrib><creatorcontrib>Golovko, Georgiy</creatorcontrib><creatorcontrib>Song, Juquan</creatorcontrib><creatorcontrib>Palackic, Alen</creatorcontrib><creatorcontrib>Wolf, Steven E.</creatorcontrib><creatorcontrib>El Ayadi, Amina</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Burns</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hallman, Taylor G.</au><au>Golovko, Georgiy</au><au>Song, Juquan</au><au>Palackic, Alen</au><au>Wolf, Steven E.</au><au>El Ayadi, Amina</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Metformin is associated with reduced risk of mortality and morbidity in burn patients compared to insulin</atitle><jtitle>Burns</jtitle><addtitle>Burns</addtitle><date>2024-09</date><risdate>2024</risdate><volume>50</volume><issue>7</issue><spage>1779</spage><epage>1789</epage><pages>1779-1789</pages><issn>0305-4179</issn><issn>1879-1409</issn><eissn>1879-1409</eissn><abstract>The standard of care for burned patients experiencing hyperglycemia associated with the hypermetabolic response is insulin therapy. Insulin treatment predisposes burn patients to hypoglycemia, which increases morbidity and mortality. Metformin has been suggested as an alternative to insulin therapy for glycemic control in burn patients given its safety profile, but further research is warranted. This study investigated whether metformin use in burn patients is associated with improved glycemic control and morbidity/mortality outcomes compared to insulin use alone.
Using the TriNetX database, we conducted a retrospective study of burned patients who were administered insulin, metformin, or both within one week of injury. Demographic, comorbidity, and burn severity information were collected. Patients were categorized by treatment type, propensity score-matched, and compared for the following outcomes within 3 months: hyperglycemia, hypoglycemia, sepsis, lactic acidosis, and death. Statistical significance was set a priori at p ≤ 0.05.
The insulin cohort was at increased risk for all outcomes (all p < 0.0001) compared to the metformin cohort, and an increased risk for sepsis, lactic acidosis, and death (all p ≤ 0.0002) compared to the insulin/metformin combination cohort. When compared to the metformin cohort, the combination cohort was at increased risk for all outcomes (all p ≤ 0.0107) except death.
Treatment with metformin after burn is associated with a reduced risk of morbidity and mortality compared to insulin. The combination of insulin and metformin is no more effective in reducing the risk of hyperglycemia and hypoglycemia than insulin alone but is less effective than metformin alone.
•Uncontrolled hyperglycemia in burned patients increases morbidity and mortality.•Insulin predisposes to hypoglycemia, which increases mortality in burned patients.•Morbidity and mortality are reduced in patients treated with metformin vs. insulin.•Metformin may serve as a viable alternative to insulin in these patients.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>38981799</pmid><doi>10.1016/j.burns.2024.05.015</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-3657-0633</orcidid><orcidid>https://orcid.org/0000-0003-4609-2767</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0305-4179 |
| ispartof | Burns, 2024-09, Vol.50 (7), p.1779-1789 |
| issn | 0305-4179 1879-1409 1879-1409 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_3077992572 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Acidosis, Lactic - chemically induced Acidosis, Lactic - epidemiology Adult Aged Burn Burns - complications Burns - drug therapy Burns - mortality Drug Therapy, Combination Female Glycemic Control - methods Humans Hyperglycemia Hyperglycemia - drug therapy Hypoglycemia Hypoglycemia - chemically induced Hypoglycemia - epidemiology Hypoglycemic Agents - therapeutic use Insulin Insulin - therapeutic use Male Metformin Metformin - therapeutic use Middle Aged Mortality Propensity Score Retrospective Studies Sepsis - drug therapy Sepsis - mortality |
| title | Metformin is associated with reduced risk of mortality and morbidity in burn patients compared to insulin |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-18T10%3A03%3A39IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Metformin%20is%20associated%20with%20reduced%20risk%20of%20mortality%20and%20morbidity%20in%20burn%20patients%20compared%20to%20insulin&rft.jtitle=Burns&rft.au=Hallman,%20Taylor%20G.&rft.date=2024-09&rft.volume=50&rft.issue=7&rft.spage=1779&rft.epage=1789&rft.pages=1779-1789&rft.issn=0305-4179&rft.eissn=1879-1409&rft_id=info:doi/10.1016/j.burns.2024.05.015&rft_dat=%3Cproquest_cross%3E3077992572%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3077992572&rft_id=info:pmid/38981799&rft_els_id=S0305417924001670&rfr_iscdi=true |