Comment on Kwon et al. The Long-term Effects of Metformin on Patients With Type 2 Diabetic Kidney Disease. Diabetes Care 2020;43:948–955
Abstract
We read with interest the recent study by Kwon et al. (1) examining the long-term effects of metformin use on mortality and incident end-stage kidney disease among 10,426 patients with type 2 diabetic kidney disease. The authors report that metformin use decreased the risk of all-cause mortality by 35% and end-stage renal disease progression by 33% after applying propensity score matching to adjust for a number of measured confounders.
We are concerned by the possible influence of immortal time bias on the study results. Immortal time arises when patients are classified into treatment groups at baseline based on treatment information that is only available after …
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