Publications
Department of Medicine faculty members published more than 3,000 peer-reviewed articles in 2022.
2015
OBJECTIVE
Many societies recommend using estimated glomerular filtration rate (eGFR) rather than serum creatinine (sCr) to determine metformin eligibility. We examined the potential impact of these recommendations on metformin eligibility among U.S. adults.
RESEARCH DESIGN AND METHODS
Metformin eligibility was assessed among 3,902 adults with diabetes who participated in the 1999-2010 National Health and Nutrition Examination Surveys and reported routine access to health care, using conventional sCr thresholds (eligible if <1.4 mg/dL for women and <1.5 mg/dL for men) and eGFR categories: likely safe, ≥45 mL/min/1.73 m(2); contraindicated, <30 mL/min/1.73 m(2); and indeterminate, 30-44 mL/min/1.73 m(2)). Different eGFR equations were used: four-variable MDRD, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine (CKD-EPIcr), and CKD-EPI cystatin C, as well as Cockcroft-Gault (CG) to estimate creatinine clearance (CrCl). Diabetes was defined by self-report or A1C ≥6.5% (48 mmol/mol). We used logistic regression to identify populations for whom metformin was likely safe adjusted for age, race/ethnicity, and sex. Results were weighted to the U.S. adult population.
RESULTS
Among adults with sCr above conventional cutoffs, MDRD eGFR ≥45 mL/min/1.73 m(2) was most common among men (adjusted odds ratio [aOR] 33.3 [95% CI 7.4-151.5] vs. women) and non-Hispanic Blacks (aOR vs. whites 14.8 [4.27-51.7]). No individuals with sCr below conventional cutoffs had an MDRD eGFR <30 mL/min/1.73 m(2). All estimating equations expanded the population of individuals for whom metformin is likely safe, ranging from 86,900 (CKD-EPIcr) to 834,800 (CG). All equations identified larger populations with eGFR 30-44 mL/min/1.73 m(2), for whom metformin safety is indeterminate, ranging from 784,700 (CKD-EPIcr) to 1,636,000 (CG).
CONCLUSIONS
The use of eGFR or CrCl to determine metformin eligibility instead of sCr can expand the adult population with diabetes for whom metformin is likely safe, particularly among non-Hispanic blacks and men.
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2015
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2015
BACKGROUND
Depressive symptoms are common in older adults and associated with increased risk of cognitive impairment. Leisure activities are often promoted for individuals with mood symptoms but few studies compare the effects of different types of leisure activities on reducing depressive symptoms.
METHODS
Data were analyzed from participants enrolled from 2008-2009 in the Mental Activity and eXercise (MAX) Trial, which examined the effects of physical plus mental activity over 12 weeks in inactive older adults with cognitive complaints. There were no significant differences between intervention groups on the primary outcome of cognitive function or the secondary outcome of depressive symptoms; therefore, all participants were combined for the current analyses in which we examined changes in leisure activity engagement (Community Healthy Activities Model Program for Seniors (CHAMPS)), and changes in depressive symptoms (Geriatric Depression Scale (GDS)) as a function of changes in leisure activity engagement from baseline to post-intervention.
RESULTS
Participants' mean age was 73.0 years, 61.6% were female, and 63.6% were non-Hispanic white. There was a significant change in total hours per week engaged in leisure activities from baseline (36.7 hours, SD = 12.7) to post-intervention (40.4 hours, SD = 15.7; paired t-test p = 0.02), and mean change in depressive symptoms was significantly inversely correlated with change in leisure activity hours such that increases in total leisure activity were associated with decreases in depressive symptoms (r = -0.21, p = 0.04).
CONCLUSIONS
Increasing the total amount of leisure activity levels may help lower depressive symptoms in inactive older adults with cognitive complaints.
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