Clinical risk associated with contrast angiography in metformin treated patients: a clinical review

Nawaz, Shah; Cleveland, T.J.; Gaines, Peter A.; Chan, Phillip

doi:10.1016/s0009-9260(98)80005-6

Cited by 59 publications

(22 citation statements)

References 10 publications

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“…Activation of AMPK requires an increase of small heterodimer partner (SHP), which in turn inhibits the expression of the hepatic gluconeogenic genes, phosphoenolpyruvate carboxy kinase (PEPCK), and Glucose-6 phosphatase (Glc-6-Pase) [34]. Metformin exhibits some toxicity to humans [6] with the most common adverse side effects being gastrointestinal symptoms, including diarrhea, cramps, nausea, vomiting, and increased flatulence [35]. Lactic acidosis can be fatal with metformin treatment at a frequency of 0.06 per 1000 patients per year [36].…”

Section: Biguanidesmentioning

confidence: 99%

“…Parenteral insulin or oral hypoglycemic agents (to stimulate pancreatic insulin secretion), and metformin (to inhibit hepatic glucose output) are effective only for lowering blood glucose levels. Metformin can be toxic to humans [6]. Rosiglitazone and pioglitazone are thought to improve insulin sensitivity, but these agents pose possible cardiac enlargement, liver damage or bladder cancer [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Prevention and Treatment of Obesity and Diabetes and their Related Complications

Song¹

2014

J Mol Genet Med

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Section: Biguanidesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevention and Treatment of Obesity and Diabetes and their Related Complications

Song¹

2014

J Mol Genet Med

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“…However, these conclusions should be treated with caution, as the quality of data and the inherent risk of bias and error associated with the publication of case reports and the use of clinical notes as a data source were not assessed. In the case series, the clinical notes in 33 inpatients who were receiving metformin and who underwent angiography were reviewed ( 18 ). Twenty-nine patients had a normal serum creatinine level before the procedure, and none showed an increased level after angiography.…”

Section: Special Report: Contrast Medium-induced Lactic Acidosis Withmentioning

confidence: 99%

“…Four patients had an abnormal serum creatinine level before the procedure, and all four patients died; two of the deaths were attributed to acute renal failure and LA, and the other two deaths were from related causes. In that case series, the authors provided little inforreview of case reports ( 17 ) and a case series ( 18 ). The researchers in the review of case reports concluded that in Flow diagram illustrates derivation of appraised studies.…”

Section: Special Report: Contrast Medium-induced Lactic Acidosis Withmentioning

confidence: 99%

Systematic Review of Current Guidelines, and Their Evidence Base, on Risk of Lactic Acidosis after Administration of Contrast Medium for Patients Receiving Metformin

Goergen¹,

Rumbold²,

Compton³

et al. 2010

Radiology

104

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, MBBS, MSc (Public Health), FAFPHM Purpose:To systematically review evidence about the relationship between metformin administration and the use of iodinated contrast medium and risk of lactic acidosis (LA) and to assess the quality of fi ve current guidelines for use of contrast medium in patients who are taking metformin. Materials and Methods:A search strategy was developed by using search terms related to metformin, contrast media, and LA. Searches were conducted in MEDLINE (Ovid), all Evidence-based Medicine Reviews (Ovid), EMBASE, and Cochrane library databases and were augmented with searches for evidence-based guidelines on radiology and evidence-based medicine Web sites by using the Google Internet search engine. Guidelines were appraised by two independent reviewers by using the Appraisal of Guidelines Research and Evaluation Collaboration Instrument. Other studies were appraised by using structured appraisal checklists. Results:Five guidelines were identifi ed and fi ve empirical studies met inclusion criteria. All guidelines had poor scores on some Appraisal of Guidelines for Research and Evaluation (AGREE) Collaboration criteria; poorer scores tended to occur in relation to objective assessment of rigor of guideline development, editorial independence, and applicability of the guideline to clinical practice. Lack of agreement was observed among guidelines about the need to stop taking metformin after contrast medium is administered, risk of LA in patients with normal renal function before contrast medium injection, recommended method of measuring renal function, and values used to defi ne abnormal function. The evidence that was used as a basis for determining the guidelines for metformin admin istration, use of contrast medium, and risk of LA consisted of a limited number of observational studies, including case reports, summaries of case reports, and case series (National Health and Medical Research Council of Australia level IV-V evidence). More important, it was not apparent that a systematic search strategy had been used to identify the studies referenced by the guidelines nor that the referenced studies had been appraised. Individual guideline recommendations were not clearly connected to cited references. Conclusion:Substantial inconsistencies exist between the recommendations of the fi ve international guidelines about contrast medium administration in patients who are taking metformin. These are, in part, caused by the low level of evidence underpinning guideline recommendations.q RSNA, 2010 Supplemental material: http://radiology.rsna.org/lookup/ suppl

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“…formin은 lactic acidosis 등의 부작용이 있으며 (5,6), troglitazone은 치명적인 간장 장해로 인해 미국 FDA에 의해 판매 중지된 상태이다 (7,8) …”

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Effects of Zinc Plus Arachidonic Acid on Insulin Resistance in High Fructose-Fed Rats

Choi¹,

Kim²,

Lee³

et al. 2009

Journal of the Korean Society of Food Science and Nutrition

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We previously demonstrated that zinc plus arachidonic acid (ZA) treatment lowered blood glucose levels in streptozotocin-induced diabetic rats, genetically diabetic obese (ob/ob) mice, and genetically diabetic, non-obese Goto-Kakizaki rats. However, plasma insulin levels did not increase with ZA treatment, suggesting that ZA lowers blood glucose levels not by stimulating pancreatic insulin secretion. However, it is unclear whether these agents lower blood glucose levels by decreasing hepatic glucose output (HGO) or by increasing glucose utilization in peripheral tissues, or both. In order to determine ZA target organ of insulin action, we divided 18 SpragueDawley rats weighing ~130 g into 3 groups (6 rats per group) and treated them for four weeks with: (1) Control diet (regular rat chow), (2) High fructose (60.0%) diet only, and (3) the same fructose diet plus zinc (10 mg/L) and arachidonic acid (50 mg/L) containing drinking water. After 4 weeks, insulin action was assessed using the hyperinsulinemic euglycemic clamp technique. Food intake and body weights were comparable in all three groups of rats throughout the study period. Plasma glucose and insulin concentrations, glucose uptake, and HGO in the basal state were all the same in these three rat groups. During the clamp study, fructose-treated and fructose＋ZA treated rat groups did not exhibit any detectable change on insulin-mediated glucose uptake compared to controls. High fructose feeding impaired insulin mediated suppression of HGO, compared to controls during clamp (4.39 vs. 2.35 mg/kg/min; p<0.05). However, ZA treatment in high fructose-fed rats showed a remarkable increase in hepatic insulin sensitivity compared to high fructose-fed rats, reflected by a complete recovery in suppression of HGO during the clamp (4.39 vs. 2.18 mg/kg/min; p<0.05). This data suggests that ZA increases insulin sensitivity in liver but not glucose utilization of peripheral tissues in high fructose-fed rats.

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Clinical risk associated with contrast angiography in metformin treated patients: a clinical review

Cited by 59 publications

References 10 publications

Prevention and Treatment of Obesity and Diabetes and their Related Complications

Prevention and Treatment of Obesity and Diabetes and their Related Complications

Systematic Review of Current Guidelines, and Their Evidence Base, on Risk of Lactic Acidosis after Administration of Contrast Medium for Patients Receiving Metformin

Effects of Zinc Plus Arachidonic Acid on Insulin Resistance in High Fructose-Fed Rats

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