Recent research published in the ‘Scientific Reports’ which investigated the impact of metformin (MET) on metabolic profile, quality of life (QoL) and survival in patients with diabetes suggests that MET treatment in patients with advanced HFrEF and diabetes is associated with improved outcome by mechanisms beyond the improvement of blood glucose control.

The study cohort included 847 stable patients with advanced HFrEF who underwent clinical and laboratory evaluation and were prospectively followed for a median of 1126 (IQRs 410; 1781) days for occurrence of death, urgent heart transplantation or mechanical circulatory support implantation. A subgroup of 44.9% had diabetes, and 22.9% of them were treated with MET.

MET-treated patients exhibited more stable HF marked by lower B-type natriuretic peptide (BNP) level (400 vs. 642 ng/l), better left ventricular (LV) and right ventricular (RV) function, lower mitral and tricuspid regurgitation severity, were using smaller doses of diuretics. Further, they had higher eGFR (69.23 vs. 63.34 ml/min/1.73 m2) and better Quality of life. Compared to individuals with diabetes treated with other glucose-lowering agents, MET-treated patients had better event-free survival even after adjustment for BNP, BMI and eGFR (p = 0.035). Propensity score-matched analysis with 17 covariates yielded 81 pairs of patients and showed a significantly better survival for MET-treated subgroup (p = 0.01). With the aforementioned observations, the investigators concluded that metformin should stay among frontline drugs for the management of HFrEF patients with diabetes.