Metformin and heart failure: never say never again

Παπάνας, Νικόλαος; Maltezos, Efstratios; Mikhailidis, Dimitri P.

doi:10.1517/14656566.2012.638283

Cited by 29 publications

(17 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, whereas, traditionally, CHF was considered a contraindication to the use of metformin, more recent evidence has shown that this should no longer be the case [37,38].…”

Section: Metformin In Patients With Congestive Heart Failurementioning

confidence: 99%

Metformin revisited: A critical review of the benefit–risk balance in at-risk patients with type 2 diabetes

Scheen

Paquot

2013

Diabetes & Metabolism

148

View full text Add to dashboard Cite

Metformin is unanimously considered as the first-line glucose-lowering agent. Theoretically, however, it cannot be prescribed in a large proportion of patients with type 2 diabetes because of the presence of numerous contraindications corresponding to situations that may increase the risk of lactic acidosis. Various observational data from real life showed that many diabetic patients considered as "at risk" still receive metformin, often without appropriate dose adjustment, apparently without any harm, especially no increased risk of lactic acidosis. More interestingly, recent data suggest that type 2 diabetes patients who are considered as being "at risk" because of the presence of traditional contraindications still take benefit from metformin therapy, with a reduction of morbidity and mortality compared with other glucose-lowering agents, more particularly sulfonylureas. The present review analyzes the benefit-risk balance of metformin therapy in special populations, namely patients with stable coronary artery disease, acute coronary syndrome or myocardial infarction, congestive heart failure, renal impairment or chronic kidney disease, hepatic dysfunction and chronic respiratory insufficiency, all conditions that may theoretically increase the risk of lactic acidosis. A special attention will be devoted to elderly patients with type 2 diabetes. Indeed, this population is growing rapidly and older patients may cumulate several comorbidities

show abstract

“…However, whereas, traditionally, CHF was considered a contraindication to the use of metformin, more recent evidence has shown that this should no longer be the case [37,38].…”

Section: Metformin In Patients With Congestive Heart Failurementioning

confidence: 99%

Metformin revisited: A critical review of the benefit–risk balance in at-risk patients with type 2 diabetes

Scheen

Paquot

2013

Diabetes & Metabolism

148

View full text Add to dashboard Cite

show abstract

“…This trend was also reflected in prescription of other medications; patients on beta blockers, loop diuretics, and potassium-sparing diuretics—agents that are largely used in the treatment of CHF—were significantly less likely to receive metformin. Providers may correctly recognize that CHF is a contraindication to metformin, or some other factor may be at work (15,20). However, there appeared to be no difference in metformin use in patients with either hepatic failure or alcohol abuse.…”

Section: Discussionmentioning

confidence: 99%

Metformin Use in Practice: Compliance With Guidelines for Patients With Diabetes and Preserved Renal Function

et al. 2017

View full text Add to dashboard Cite

IN BRIEF Several contraindications limit the use of metformin, most notably the risk of lactic acidosis. This article reports on an examination of a population of patients with diabetes with preserved renal function to evaluate provider compliance with guidelines on metformin use and to identify factors that contributed when practice diverged from recommendations. It found that metformin was withheld from approximately one-third of these patients because of 1) an existent contraindication to metformin, 2) patient behavior or preference, or 3) provider preference or bias based on patient or personal factors. Although providers generally follow current recommendations for the use of metformin, deviations from guidelines in practice are common.

show abstract

“…Metformin is contraindicated in patients within two weeks after stroke (Glycaemia in Acute Stroke (GLIAS), UK Glucose Insulin in Stroke Trial (GIST-UK), Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction (DIGAMI))[47-52]. Metformin bears the additional risk of lactic acidosis, especially in patients with recent myocardial infarction but it is not contraindicated in patients with cardiovascular disease; indeed, recent studies have suggested that it may be beneficial [53-55]. Glitazones should not be used in Stage III-IV heart failure as they can exacerbate the condition.…”

Section: Discussionmentioning

confidence: 99%

Personalizing guidelines for diabetes management: twilight or dawn of the expert?

Paschou

Leslie

2013

BMC Med

View full text Add to dashboard Cite

BackgroundThis opinion article on the management of type 2 diabetes considers the old and new format of guidelines and critical changes in the character of such guidelines. We highlight limitations of the guidelines and make recommendations for how treatment can be more personalised.DiscussionPublished guidelines for the management of adult-onset non-insulin requiring diabetes have adopted a formulaic approach to patient management that can be overseen centrally and delivered by personnel with limited training. Recently, guidelines have taken a patient-centered, multiple risk-factor approach. Importantly, local funding issues are considered, but drive the final action and not the decision-making process. The nature of the disease can be determined by laboratory tests, including screening for diabetes-associated autoantibodies. The strategy remains step-up, with intensification of drug or insulin dose. As with past guidelines, there is an assumption that in each patient with type 2 diabetes, metformin is used initially, but targets and therapies then veer in different directions to create a matrix of options based on the features and responses of each individual. Factors to consider include: (A)ge, (B)ody weight, (C)omplications and co-morbidities, Diabetes (D)uration and (E)xpense, but also patient preference and patient response.SummaryGuidelines for the management of type 2 diabetes have important limitations and a patient-centered, multiple target, multiple therapy approach is proposed.

show abstract

Metformin and heart failure: never say never again

Cited by 29 publications

References 51 publications

Metformin revisited: A critical review of the benefit–risk balance in at-risk patients with type 2 diabetes

Metformin revisited: A critical review of the benefit–risk balance in at-risk patients with type 2 diabetes

Metformin Use in Practice: Compliance With Guidelines for Patients With Diabetes and Preserved Renal Function

Personalizing guidelines for diabetes management: twilight or dawn of the expert?

Contact Info

Product

Resources

About