The study results suggest that, in patients with both advanced heart failure and diabetes, use of metformin is safe, and may be associated with better heart failure survival.

Overall, diabetes is the leading cause of ESRD in the United states, accounting for more than one third of cases.

As the increasing incidence of diabetes and early-rising trend makes advanced Diabetic Lower-extremity Arteriosclerosis Obliteration (DLASO) patients is increasing.