Effect of Metformin in Diabetic Patients After Treatment of Intracranial Aneurysm: A Nationwide Cohort Study.

Metformin use was associated with a reduced risk of subarachnoid hemorrhage in diabetic patients treated for intracranial aneurysm.

• Adjusted hazards ratio of 0.63 (95% confidence interval, 0.41–0.95; P = 0.028)
• Of 14,086 diabetic patients treated for IA, 9,612 (68.2%) were metformin users
• During a mean follow-up of 4.6 years, 120 (0.9%) patients experienced SAH
• Finding was consistent across subgroup, propensity score matching, and time-varying Cox regression analyses

The study cohort consisted of diabetic patients who underwent surgical clipping or endovascular coiling for intracranial aneurysm identified from Korean health insurance claims data.

• Retrospective cohort study design using nationwide Korean health insurance claims data
• Patients treated between January 2009 and December 2020
• Total of 14,086 diabetic patients were included
• Primary outcome was the development of subarachnoid hemorrhage

Experimental data have previously shown that metformin has protective effects against intracranial aneurysm rupture.

• Metformin is described as an antidiabetic agent with potential vascular protective properties
• Intracranial aneurysm is identified as the most common cause of subarachnoid hemorrhage
• Subarachnoid hemorrhage from IA is associated with high morbidity and mortality
• Prior experimental findings motivated this clinical investigation of metformin's long-term effects

The authors concluded that metformin should be considered the preferred antidiabetic agent for diabetic patients treated for intracranial aneurysm.

• Findings support the use of metformin as the preferred antidiabetic agent for such patients considering these benefits
• The association between metformin and reduced SAH risk was consistent across multiple analytical approaches including propensity score matching and time-varying Cox regression