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      Metformin Use Is Associated with a Lower Risk of Inflammatory Bowel Disease in Patients with Type 2 Diabetes Mellitus

      1 , 2 , 3
      Journal of Crohn's and Colitis
      Oxford University Press (OUP)

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          Abstract

          Aim

          Our aim was to compare the risk of developing inflammatory bowel disease [IBD] between ever users and never users of metformin.

          Methods

          Patients with newly diagnosed type 2 diabetes mellitus from 1999 to 2005 were enrolled from Taiwan’s National Health Insurance. A total of 340 211 ever users and 24 478 never users who were free from IBD on January 1, 2006 were followed up until December 31, 2011. Hazard ratios were estimated by Cox regression incorporating the inverse probability of treatment weighting using a propensity score.

          Results

          New-onset IBD was diagnosed in 6466 ever users and 750 never users. The respective incidence rates were 412.0 and 741.3 per 100 000 person-years and the hazard ratio for ever vs never users was 0.55 [95% confidence interval: 0.51–0.60]. A dose–response pattern was observed while comparing the tertiles of cumulative duration of metformin therapy to never users. The respective hazard ratios for the first [<26.0 months], second [26.0–58.3 months] and third [>58.3 months] tertiles were 1.00 [0.93–1.09], 0.57 [0.52–0.62] and 0.24 [0.22–0.26]. While patients treated with oral antidiabetic drugs [OADs] without metformin were treated as a reference group, the hazard ratios for patients treated with OADs with metformin, with insulin without metformin [with/without other OADs] and with insulin and metformin [with/without other OADs] were 0.52 [0.42–0.66], 0.95 [0.76–1.20] and 0.50 [0.40–0.62], respectively.

          Conclusion

          A reduced risk of IBD is consistently observed in patients with type 2 diabetes mellitus who have been treated with metformin.

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          Most cited references33

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          Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies.

          Inflammatory bowel disease is a global disease in the 21st century. We aimed to assess the changing incidence and prevalence of inflammatory bowel disease around the world.
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            Is Open Access

            Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies

            The propensity score is defined as a subject's probability of treatment selection, conditional on observed baseline covariates. Weighting subjects by the inverse probability of treatment received creates a synthetic sample in which treatment assignment is independent of measured baseline covariates. Inverse probability of treatment weighting (IPTW) using the propensity score allows one to obtain unbiased estimates of average treatment effects. However, these estimates are only valid if there are no residual systematic differences in observed baseline characteristics between treated and control subjects in the sample weighted by the estimated inverse probability of treatment. We report on a systematic literature review, in which we found that the use of IPTW has increased rapidly in recent years, but that in the most recent year, a majority of studies did not formally examine whether weighting balanced measured covariates between treatment groups. We then proceed to describe a suite of quantitative and qualitative methods that allow one to assess whether measured baseline covariates are balanced between treatment groups in the weighted sample. The quantitative methods use the weighted standardized difference to compare means, prevalences, higher‐order moments, and interactions. The qualitative methods employ graphical methods to compare the distribution of continuous baseline covariates between treated and control subjects in the weighted sample. Finally, we illustrate the application of these methods in an empirical case study. We propose a formal set of balance diagnostics that contribute towards an evolving concept of ‘best practice’ when using IPTW to estimate causal treatment effects using observational data. © 2015 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.
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              Introduction to the Analysis of Survival Data in the Presence of Competing Risks

              Supplemental Digital Content is available in the text.
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                Author and article information

                Contributors
                (View ORCID Profile)
                Journal
                Journal of Crohn's and Colitis
                Oxford University Press (OUP)
                1873-9946
                1876-4479
                January 01 2021
                January 13 2021
                July 01 2020
                January 01 2021
                January 13 2021
                July 01 2020
                : 15
                : 1
                : 64-73
                Affiliations
                [1 ]Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
                [2 ]Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
                [3 ]Division of Environmental Health and Occupational Medicine of the National Health Research Institutes, Zhunan, Taiwan
                Article
                10.1093/ecco-jcc/jjaa136
                32604412
                e8d4715c-8d19-408b-b62c-a5cb153d5fa5
                © 2020

                https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model

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