Evidence map›Paper›PMID 26034780›Full record

ArticleThe Lancet. Haematology2015

Association between metformin use and progression of monoclonal gammopathy of undetermined significance to multiple myeloma in US veterans with diabetes mellitus: a population-based retrospective cohort study.

Su-Hsin Chang, Suhong Luo, Katiuscia K O'Brian, Theodore S Thomas, Graham A Colditz, Nils P Carlsson, Kenneth R Carson

Erratum issuedAbstract read
In one paragraph

Article in The Lancet. Haematology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 50 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
50citing papers in PubMed, 2 pooled it
3.2field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

50 citing papers in PubMed, 2 syntheses or guidelines pooled it, 76 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Trial
  5. Article
  6. Article
  7. Review
  8. Article
  9. Article
  10. Article
  11. Review
  12. Article
  13. Article
  14. Review
  15. Article
  16. Article
  17. Review
  18. Review
  19. Article
  20. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

Su-Hsin Chang
Suhong Luo
Katiuscia K O'Brian
Theodore S Thomas
Graham A Colditz
Nils P Carlsson
Kenneth R Carson
Washington University in St. Louis · US

Funding

Worksite Policies and neighborhood Influences on Obesity and Cancer RiskU54CA155496 · NCI · WASHINGTON UNIVERSITY · PI COLDITZ, GRAHAM A. · 2011 to 2016
$9.0M
OBESITY, COMORBIDITIES, AND ECONOMIC EVALUATIONS OF SURGICAL TREATMENTS OF OBESITK01HS022330 · AHRQ · WASHINGTON UNIVERSITY · PI CHANG, SU-HSIN · 2013 to 2016
$505k
AHRQ HHS K01 HS022330AHRQ HHS K01-HS022330NCI NIH HHS U54 CA155496NCI NIH HHS U54-CA155496
6 · The paper itself

Abstract

backgroundMultiple myeloma is one of the most common haematological malignancies in the USA and is consistently preceded by monoclonal gammopathy of undetermined significance (MGUS). We aimed to assess the association between metformin use and progression of MGUS to multiple myeloma.

methodsWe did a retrospective cohort study of patients registered in the US Veterans Health Administration database and diagnosed with MGUS between Oct 1, 1999, and Dec 31, 2009. We included patients (aged >18 years) with at least one International Classification of Diseases (9th revision) code for diabetes mellitus and one treatment for their diabetes before MGUS diagnosis. We reviewed patient-level clinical data to verify diagnoses and extract any available data for size of baseline M-protein and type of MGUS. We defined metformin users as patients with diabetes who were given metformin consistently for 4 years after their diabetes diagnosis and before multiple myeloma development, death, or censorship. Our primary outcome was time from MGUS diagnosis to multiple myeloma diagnosis. We used Kaplan-Meier curves and Cox models to analyse the association between metformin use and MGUS progression.

findingsWe obtained data for 3287 patients, of whom 2003 (61%) were included in the final analytical cohort. Median follow-up was 69 months (IQR 49–96). 463 (23%) participants were metformin users and 1540 (77%) participants were non-users. 13 (3%) metformin users progressed to multiple myeloma compared with 74 (5%) non-users. After adjustment, metformin use was associated with a reduced risk of progression to multiple myeloma (hazard ratio 0·47, 95% CI 0·25–0·87).

interpretationFor patients with diabetes diagnosed with MGUS, metformin use for 4 years or longer was associated with a reduced risk of progression of MGUS to multiple myeloma. Prospective studies are needed to establish whether this association is causal and whether these results can be extrapolated to non-diabetic individuals.

fundingBarnes-Jewish Hospital Foundation, National Institutes of Health, Agency for Healthcare Research and Quality, American Cancer Society.

Indexed as

AgedDiabetes MellitusFemaleHumansMaleMetforminMiddle AgedMonoclonal Gammopathy of Undetermined SignificanceMultiple MyelomaRetrospective StudiesRisk FactorsVeteransMetformin

Identifiers

PMID26034780
PMCPMC4448731
OpenAlexW2167969404

What OpenQuestion holds

Texttitle and abstract
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.