A new study published in Diabetes research and Clinical Practice suggests that the most effective anti-diabetic medication for people with type 2 diabetes is the combined treatment of Metformin (MET) and thiazolidinedione (TZD).
While data on the relationship between AF risk and anti-diabetic medications are scarce, diabetes is a risk factor for atrial fibrillation (AF). The purpose of this study, which was carried out by Sunyoung Kim and colleagues, was to assess how anti-diabetic medications affected the incidence of AF in Korean patients with type 2 diabetes.

The Korean National Insurance Service database had 2,515,468 type 2 diabetic patients without a history of AF who underwent health examinations between 2009 and 2012. According to the primary anti-diabetic medication combinations used in the actual world up until December 2018, the incidence of newly diagnosed AF was observed.
The key findings of this study were:
89,125 patients (mean age, 62 11 years; 60% men) have just received an AF diagnosis.
Metformin (MET) combination treatment (HR 1) and MET alone (HR 0.959, 95% CI 0.935-0.985) both markedly reduced the probability of AF in comparison to the non-medication group.
Even after controlling for a number of variables, MET (HR 0.977, 95% CI 0.964-0.99) and thiazolidinedione (TZD; HR 0.926, 95% CI 0.898-0.956) were the two anti-diabetic medications that consistently shown a protective effect against the occurrence of AF.
Moreover, compared to other medication combinations, this protective effect was more notable with MET and TZD combination treatment (HR 0.802, 95% CI 0.754-0.853).
Regardless of age, sex, length, or the severity of the diabetes, the preventative impact of MET and TZD therapy against AF was constant in the subgroup analysis.
In conclusion, thiazolidinedione and metformin both exhibited a protective effect against the occurrence of AF, however the combination of MET & TZD was the most successful one, reducing the risk of AF incidence by 20%.
Reference:
Kim, S., Park, S. Y., Kim, B., Min, C., Cho, W., Yon, D. K., Kim, J. Y., Han, K.-D., Rhee, E.-J., Lee, W.-Y., & Rhee, S. Y. (2023). Association between antidiabetic drugs and the incidence of atrial fibrillation in patients with type 2 diabetes: A nationwide cohort study in South Korea. In Diabetes Research and Clinical Practice (Vol. 198, p. 110626). Elsevier BV. https://doi.org/10.1016/j.diabres.2023.110626