Metformin for Knee Osteoarthritis in Patients With Overweight or Obesity: A Randomized Clinical Trial

Importance: Preclinical and preliminary human evidence suggests that metformin, a first-line treatment for type 2 diabetes, reduces inflammation, preserves cartilage, and improves knee pain in knee osteoarthritis.

Objective: To evaluate the effects of metformin on knee pain at 6 months in participants with symptomatic knee osteoarthritis and overweight or obesity.

Design, setting, and participants: Community-based randomized, parallel-group, double-blind, placebo-controlled clinical trial that used telemedicine to recruit and follow up participants remotely. Individuals with knee pain for 6 months or longer, a pain score greater than 40 mm on a 100-mm visual analog scale (VAS), and body mass index of 25 or higher were recruited from the community through local and social media advertisements in Victoria, Australia, between June 16, 2021, and August 1, 2023. Final follow-up occurred on February 8, 2024.

Interventions: Participants were randomly assigned to receive either oral metformin, 2000 mg/d (n = 54), or identical placebo (n = 53) for 6 months.

Main outcomes and measures: The primary outcome was change in knee pain, measured using a 100-mm VAS (score range, 0-100; 100 = worst; minimum clinically important difference = 15) at 6 months.

Results: Of 225 participants assessed for eligibility, 107 (48%) were randomized (mean age, 58.8 [SD, 9.5] years; 68% female) and assigned to receive metformin or placebo. Eighty-eight participants (82%) completed the trial. At 6 months, the mean change in VAS pain was -31.3 mm in the metformin group and -18.9 mm in the placebo group (between-group difference, -11.4 mm; 95% CI, -20.1 to -2.6 mm; P = .01), corresponding to an effect size (standardized mean difference) of 0.43 (95% CI, 0.02-0.83). The most common adverse events were diarrhea (8 [15%] in the metformin group and 4 [8%] in the placebo group) and abdominal discomfort (7 [13%] in the metformin group and 5 [9%] in the placebo group).

Conclusions and relevance: These results support use of metformin for treatment of symptomatic knee osteoarthritis in people with overweight or obesity. Because of the modest sample size, confirmation in a larger clinical trial is warranted.

Author/s:

Feng Pan, Yuanyuan Wang, Yuan Z Lim, Donna M Urquhart

Optimization of type 2 diabetes care in adults aged 65 or older: Practical approach to deintensification

Alex Haga — Thu, 20 Jun 2024 21:18:18 +0000

Date Added:

June 20, 2024

Journal/Publication:

Canadian Family Physician

Publication Date:

June 1, 2024

Issue:

Volume:

Pages:

391-394

URL:

Optimization of type 2 diabetes care in adults aged 65 or older: Practical approach to deintensification

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.46747/cfp.7006391

Keywords

diabetes

blood glucose

aged

PMID (1):

38886078

MeSH

diabetes mellitus

Type 2* / therapy

Hypoglycemic Agents* / therapeutic use

aged

Aged, 80 and over

aged

The benefits of lowering blood glucose levels are limited and potentially burdensome and even dangerous in people with limited life expectancies. Diabetes management in those over 65, in particular, should be individualized. James W. Mold, MD, MPH

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Effective diabetes management, particularly in older and frail adults, requires a nuanced approach that balances the benefits of antihyperglycemic medications with the risks of intensive glycemic control. While certain diabetes medications are important to the prevention of chronic complications of diabetes, intensive glycemic management can increase the risk of hypoglycemia, potentially leading to serious adverse outcomes (eg, falls, seizures, hospitalizations, death). In patients aged 65 or older and those with frailty, a tailored approach to diabetes care is crucial. A patient-centred approach might include individualizing glycemic targets and reducing the intensity of both pharmacologic treatment and routine monitoring to prioritize patient safety and quality of life. Implementing such patient-centred care requires clinicians to thoroughly consider each patient’s overall health, preferences, and social context, thus ensuring that treatment decisions align with the patient’s personal goals of care and life circumstances.

Author/s:

Julia B Bardoczi, Carole E Aubert