Niesner The study design also excluded those who began diabetes treatment after the onset of reduced kidney function. Skali  D.  Estimating and using propensity scores with partially missing data. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). FDA drug safety communication: FDA revises warnings regarding use of the diabetes medicine metformin in certain patients with reduced kidney function. use prohibited. Patel UK Prospective Diabetes Study (UKPDS) Group. Geiss Medical record review and validation of a sample of these codes have shown high specificity and positive predictive values of 90% for AMI and 81% for stroke when compared with VHA medical record review.Cardiovascular deaths were identified from death certificates with an The secondary outcome excluded TIA as part of the composite MACE event.  J, Turin Patients were censored on the 181st day without medical contact (inpatient, outpatient, or pharmacy use) or nonpersistence, defined as the 91st day without the hypoglycemic therapy or addition of a second hypoglycemic drug, reaching the previously described creatinine threshold, death, or study end (December 31, 2011). Holman Use of metformin to treat diabetes now expanded to patients with moderately reduced kidney function.  J, Gray  J, Turin The first, by Ekström et al,This study has several limitations. Those who initiated thiazolidinedione (N=10 164) versus metformin (N=10 200) had 25.7 (21.6, 30.6) versus 14.9 (11.9, 18.7) events per 1000 person‐years (aHR 1.72 [1.36, 2.18]) (Table Our finding of increased hazard for the composite outcome among sulfonylurea users could in theory have resulted from an unmeasured covariate that is associated with heart failure and was more prevalent among sulfonylurea than metformin users. Study Cohort and Patient Characteristics After covariate adjustment, the cause-specific adjusted HR (aHR) for MACE was 0.80 (95% CI, 0.75-0.86) among metformin users compared with sulfonylurea. Commonly reported Follow‐up began at 180 days after the incident prescription and continued through an outcome (described below) or censoring event.  et al.  R.  A proportional hazards model for the subdistribution of a competing risk. D’Agostino A meta‐analysis and metaregressionPossible explanations for our findings include differential medication effects on BMI, as evident in our cohort and others,Our study does have limitations.  R.  A proportional hazards model for the subdistribution of a competing risk.  JM, Eddings  H, de Groot  W, Austin  K, Murray  K, Murff Glipizide vs. Metformin Glipizide is Sulfonylurea while Metformin is biguanide. This study and the results add to the limited observational evidence for the beneficial association of metformin compared with sulfonylurea and cardiovascular outcomes among those who develop reduced kidney function.Although there is consensus that metformin is first-line diabetes treatment, metformin is discontinued in many patients when kidney disease develops.  MM, Roumie  et al.  AM,  J, Metformin improves how the body responds to insulin and it is effective for the treatment of type 2 diabetes.  Jr, Huizinga Austin There were 126 867 and 79 192 new users of metformin and sulfonylurea, respectively.