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Disease latency bias and the protective effect of metformin against age-related macular degeneration

Eye (2024)Cite this article

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Thank you to Ling et al. [1] for their timely reminder about disease latency bias. This is where patients with symptoms are more likely to attend a physician and therefore have a switch in their medication (for any condition); whereas the patients without symptoms and no physician contact remain on an older, less fashionable medication. There arises a spurious association between the older medication and absence of the condition causing symptoms.

Their chosen example of metformin being protective for AMD is problematic. Metformin is an old medication, but it remains the first-line treatment for adults with type 2 diabetes (NICE Guidance 28 [2], American Diabetes Association [3] and Diabetes Association of Taiwan [4]). Guidelines indicate that patients should remain on metformin even as other diabetes medications are added. Furthermore, patients with diabetes should be having regular review, including a review of their medications anyway. So, a physician visit for visual symptoms is unlikely to provoke an opportunistic comprehensive diabetes review and discontinuation of metformin in favor of another medication.

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References

  1. Ling JYM, Mansournia MA, Etminan M. Disease latency bias and the protective effect of metformin against age-related macular degeneration. Eye. 2024. https://doi.org/10.1038/s41433-024-02993-7.

  2. NICE. NICE Guideline 28 Type 2 diabetes in adults: management. 2022. https://www.nice.org.uk/guidance/ng28/chapter/Recommendations#drug-treatment

  3. ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2023. Diabetes Care. 2023;46:S140–S157. https://doi.org/10.2337/dc23-S009

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  4. Diabetes Association of the Republic of China (Taiwan). Executive summary of the DAROC clinical practice guidelines for diabetes care- 2018. J Formosan Med Assoc. 2023;19:577–86.

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  5. Romdhoniyyah DF, Harding SP, Cheyne CP, Beare NAV. Metformin, a potential role in age-related macular degeneration: a systematic review and meta-analysis. Ophthalmol Ther. 2021;10:245–60. https://doi.org/10.1007/s40123-021-00344-3

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  1. Department of Eye and Vision Science, University of Liverpool, William Henry Duncan Building, Liverpool, L7 8TX, UK

    Nicholas Beare

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Correspondence to Nicholas Beare.

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Beare, N. Disease latency bias and the protective effect of metformin against age-related macular degeneration. Eye (2024). https://doi.org/10.1038/s41433-024-03112-2

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