Monotherapy with Metformin vs. Sulfonylureas for Type 2 Diabetes with Impaired Kidney Function

In 1995, the FDA approved metformin for patients with type 2 diabetes; however, the label advised clinicians to avoid prescribing metformin to patients with impaired kidney function because of concerns about lactic acidosis. But in 2016, the FDA endorsed metformin's safety in patients with mild-to-moderate kidney function impairment. To determine whether risk for death differs following initiation of metformin monotherapy or sulfonylurea monotherapy among veterans with type 2 diabetes and chronic kidney disease, researchers conducted this cohort study of 175,000 patients who initiated these drugs as monotherapy at Veterans Affairs hospitals between 2004 and 2009.

About 5000 deaths occurred during follow-up. Adjusted for multiple potential co…