Published online Nov 26, 2021. doi: 10.12998/wjcc.v9.i33.10198
Peer-review started: July 9, 2021
First decision: August 8, 2021
Revised: August 9, 2021
Accepted: September 10, 2021
Article in press: September 10, 2021
Published online: November 26, 2021
Neuropathy is a common chronic complication in type 2 diabetes mellitus (T2DM). Statin and metformin are commonly used medications in T2DM patients, and some studies showed statin- or metformin-induced neuropathy.
To evaluate the incidence of neuropathy among patients with T2DM associated with statin and metformin therapies.
Korean Health Insurance Review and Assessment national patient sample data from 2016 and 2017 were used. Patients with T2DM and no complications were divided into statin/metformin/statin + metformin users and non-users. Neuropathy incidence was defined by International Statistical Classification of Diseases and Related Health Problems, 10th revision codes and concomitant prescriptions for anticonvulsants or antidepressants. Logistic regression analyses were conducted to examine the associations between statin/metformin/statin + metformin therapies and the incidence of neuropathy. Propensity score (PS) matching was performed on the basis of age, sex and comorbidities.
Overall, 34964 and 35887 patients with T2DM and no complications were included in the Korean Health Insurance Review and Assessment national patient sample datasets from 2016 and 2017, respectively. Statin therapy was associated with increased risks of neuropathy in 2016 and 2017 [PS-matched odds ratio (OR) = 1.22, 95% confidence interval (CI): 1.08-1.38; PS-matched OR = 1.17, 95%CI: 1.03-1.33, respectively]. Metformin therapy was associated with reduced risks of neuropathy in 2016 and 2017 (PS-matched OR = 0.30, 95%CI: 0.21-0.42; PS-matched OR = 0.44, 95%CI: 0.32-0.60, respectively). Combined statin + metformin therapy was not significantly associated with neuropathy in 2016 or 2017 (PS-matched OR = 0.85, 95%CI: 0.61-1.19; PS-matched OR = 0.95, 95%CI: 0.66-1.38, respectively).
Statin therapy was associated with enhanced risk of new-onset neuropathy in patients with T2DM, but metformin therapy showed the opposite association.
Core Tip: Diabetic neuropathy is one of the most common chronic complications in patients with type 2 diabetes mellitus. Statin is a commonly used lipid lowering agent in patients with type 2 diabetes mellitus, and metformin is background medication for type 2 diabetes mellitus. In some observational studies, statin and metformin were associated with an increased risk of neuropathy. In the present study using Korean Health Insurance Review and Assessment national patient sample data, the use of statin was associated with increased risk of diabetic neuropathy occurrence, whereas metformin use showed a negative association with diabetic neuropathy.