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      The potential benefit of metformin to reduce delirium risk and mortality: a retrospective cohort study

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          Abstract

          Purpose: Metformin has been reported to improve age-related disorders, including dementia, and to lower mortality. This study was conducted to investigate whether metformin use lower delirium risk, as well as long-term mortality.

          Methods: In this retrospective cohort study, previously recruited 1,404 subjects were analyzed. The relationship between metformin use and delirium, and the relationship between metformin use and 3-year mortality were investigated.

          Main findings: 242 subjects were categorized into a type 2 diabetes mellitus (DM)-without-metformin group, and 264 subjects were categorized into a DM-with-metformin group. Prevalence of delirium was 36.0% in the DM-without-metformin group, and 29.2% in the DM-with-metformin group. A history of metformin use reduced the risk of delirium in patients with DM (OR, 0.50 [95% CI, 0.32 to 0.79]) after controlling for confounding factors. The 3-year mortality in the DM-without-metformin group (survival rate, 0.595 [95% CI, 0.512 to 0.669]) was higher than in the DM-with-metformin group (survival rate, 0.695 [95% CI, 0.604 to 0.770]) (p=0.035). A history of metformin use decreased the risk of 3-year mortality after adjustment for confounding factors (HR, 0.69 [95% CI, 0.48 to 0.98]).

          Conclusions: Metformin use may lower the risk of delirium and mortality in DM patients.

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          Most cited references61

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          Diagnostic and Statistical Manual of Mental Disorders

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            Investigation of the freely available easy-to-use software ‘EZR' for medical statistics

            Y Kanda (2012)
            Although there are many commercially available statistical software packages, only a few implement a competing risk analysis or a proportional hazards regression model with time-dependent covariates, which are necessary in studies on hematopoietic SCT. In addition, most packages are not clinician friendly, as they require that commands be written based on statistical languages. This report describes the statistical software ‘EZR' (Easy R), which is based on R and R commander. EZR enables the application of statistical functions that are frequently used in clinical studies, such as survival analyses, including competing risk analyses and the use of time-dependent covariates, receiver operating characteristics analyses, meta-analyses, sample size calculation and so on, by point-and-click access. EZR is freely available on our website (http://www.jichi.ac.jp/saitama-sct/SaitamaHP.files/statmed.html) and runs on both Windows (Microsoft Corporation, USA) and Mac OS X (Apple, USA). This report provides instructions for the installation and operation of EZR.
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              Delirium in elderly people.

              Delirium is an acute disorder of attention and cognition in elderly people (ie, those aged 65 years or older) that is common, serious, costly, under-recognised, and often fatal. A formal cognitive assessment and history of acute onset of symptoms are necessary for diagnosis. In view of the complex multifactorial causes of delirium, multicomponent non-pharmacological risk factor approaches are the most effective strategy for prevention. No convincing evidence shows that pharmacological prevention or treatment is effective. Drug reduction for sedation and analgesia and non-pharmacological approaches are recommended. Delirium offers opportunities to elucidate brain pathophysiology--it serves both as a marker of brain vulnerability with decreased reserve and as a potential mechanism for permanent cognitive damage. As a potent indicator of patients' safety, delirium provides a target for system-wide process improvements. Public health priorities include improvements in coding, reimbursement from insurers, and research funding, and widespread education for clinicians and the public about the importance of delirium. Copyright © 2014 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Aging (Albany NY)
                Aging
                Aging (Albany NY)
                Impact Journals
                1945-4589
                30 November 2022
                17 November 2022
                : 14
                : 22
                : 8927-8943
                Affiliations
                [1 ]Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA 94305, USA
                [2 ]University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA
                [3 ]Tottori University Faculty of Medicine, Department of Neuropsychiatry, Yonago-Shi, Tottori, Japan
                [4 ]University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, IA 52242, USA
                [5 ]University of Iowa College of Public Health, Department of Biostatistics, Iowa City, IA 52242, USA
                [6 ]University of Iowa Carver College of Medicine, Department of Internal Medicine, Iowa City, IA 52242, USA
                Author notes
                Correspondence to: Gen Shinozaki; email: gens@stanford.edu
                Article
                204393 204393
                10.18632/aging.204393
                9740381
                36399107
                6a5e789e-a136-4f44-91e6-26d49b18842a
                Copyright: © 2022 Yamanashi et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 26 July 2022
                : 27 October 2022
                Categories
                Research Paper

                Cell biology
                delirium,metformin,diabetes mellitus,mortality,aging
                Cell biology
                delirium, metformin, diabetes mellitus, mortality, aging

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