Metformin and Mortality after Surgery: a Systematic Review and Meta-Analysis

Editor—Poor glucose control is independently associated with adverse outcomes (including higher mortality) after noncardiac surgery, independent of a preoperative diagnosis of diabetes mellitus.1 Glucose control using the first-line therapeutic metformin in the long-term management of type 2 diabetes mellitus2 reflects not only a role for metformin in lowering glucose, but also the pleiotropic, anti-inflammatory properties of metformin.3 The reduction in all-cause mortality associated with metformin exposure cannot be explained solely by glucose control.