Metformin–thiazolidinedione combo best bet for AF prevention in T2D

Combination therapy with metformin and thiazolidinedione appears to be the best performing glucose-lowering medication for preventing atrial fibrillation (AF) in patients with type 2 diabetes (T2D), as shown in a study.

The study involved 2,515,468 T2D patients (mean age 62 years, 60 percent male) from the Korean National Insurance Service database. These patients had no history of AF and underwent health check-ups between 2009 and 2012. The incidence of newly diagnosed AF was recorded until 2018, stratified according to the main antidiabetic drug combinations used in the real world.

During follow-up, 89,125 patients had a newly diagnosed AF. The risk of AF was significantly lower among patients exposed to metformin alone (hazard ratio [HR], 0.959, 95 percent confidence interval [CI], 0.935–0.985) or to the combination therapy (HR <1) than among those who received no medication.

Among the glucose-lowering drugs evaluated, metformin consistently exerted a protective effect against AF incidence (HR, 0.977, 95 percent CI, 0.964–0.99), as did thiazolidinedione (HR, 0.926, 95 percent CI, 0.898–0.956), despite adjustments for various factors.

Furthermore, the protective benefit was more pronounced with the combination of metformin and thiazolidinedione (HR, 0.802, 95 percent CI, 0.754–0.853) than with other drug combinations.

Subgroup analysis showed that the preventive effect of metformin and thiazolidinedione treatment against AF remained consistent, regardless of age, sex, duration, and diabetes severity.