Metformin in patients with type 2 diabetes mellitus: reconsideration of traditional contraindications

Rachmani, Rita; Slavachevski, Inna; Levi, Zohar; Zadok, Bat-Sheva; Kedar, Y.; Ravid, Mordchai

doi:10.1016/s0953-6205(02)00131-0

Cited by 125 publications

(110 citation statements)

References 27 publications

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“…Most studies of patients with type 2 diabetes, including those over 70 years of age and those with mild renal failure, have shown that metformin treatment is not associated with significantly increased plasma lactate levels, as compared with other forms of treatment [17,[25][26][27][28]. In some, however, a non-significant trend was seen [17,28] or post-meal lactate peaks were increased [25].…”

Section: Serum Concentration Of Lactate and Metforminmentioning

confidence: 99%

“…An Israeli study [27] investigated 393 patients with type 2 diabetes and multiple comorbidities and explicit contraindications to metformin, particularly, chronic renal insufficiency (serum creatinine 130-220 μmol/l), coronary heart disease (n=266), chronic heart failure (New York Heart Association [NYHA] stage III or IV) (n=94), liver disease (n=51) and chronic obstructive lung disease (n=91). These patients were randomly assigned to continued metformin or no further treatment.…”

Section: Disregard Of Metformin Contraindications and Incidence Of Lamentioning

confidence: 99%

“…Evidence from meta-analyses [34] and prospective studies does however suggest that metformin can be used safely in chronic renal insufficiency with a creatinine of up to 133 μmol/l [26,27]. It must be borne in mind, however, that serum creatinine generally overestimates renal function, particularly in the elderly and in the obese with reduced muscle mass.…”

Section: Suggested Modifications Of Metformin Contraindicationsmentioning

confidence: 99%

“…In fact, there is evidence suggesting that metformin can be safely taken by patients with more severe heart failure [27]. However, the drug must be withdrawn immediately in the event of acute myocardial infarction or other intercurrent diseases with generalised hypoxia and hypoperfusion, as such disorders can themselves cause lactic acidosis.…”

Section: Suggested Modifications Of Metformin Contraindicationsmentioning

confidence: 99%

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Contraindications can damage your health—is metformin a case in point?

2005

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Metformin is an effective anti-hyperglycaemic and cardioprotective agent, but a long list of contraindications precludes millions of patients with type 2 diabetes from using it. This is largely due to the historical experience of lactic acidosis with phenformin, despite the fact that metformin does not predispose to this when compared with other therapies. Contraindications such as old age, renal impairment and cardiac insufficiency are increasingly disregarded in clinical practice, yet there is no evidence that the incidence of lactic acidosis has changed. Metformin has been shown to improve metabolic control without causing lactic acidosis in elderly patients with multiple comorbidities, including explicit contraindications, and its use in patients with type 2 diabetes over the age of 70 with mild renal impairment did not produce a clinically relevant increase in plasma lactate. There is no correlation between levels of metformin and lactate in patients with lactic acidosis, and its prognosis is mainly related to the causal hypoxic underlying disease and comorbidities. These findings raise doubts about the pathogenetic significance of metformin in lactic acidosis. We propose that advanced age per se, mild renal impairment and compensated heart failure can no longer be upheld as contraindications for metformin. A clear re-definition of contraindications to metformin will enable more physicians to prescribe within guidelines.

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Section: Serum Concentration Of Lactate and Metforminmentioning

confidence: 99%

Section: Disregard Of Metformin Contraindications and Incidence Of Lamentioning

confidence: 99%

Section: Suggested Modifications Of Metformin Contraindicationsmentioning

confidence: 99%

Section: Suggested Modifications Of Metformin Contraindicationsmentioning

confidence: 99%

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Contraindications can damage your health—is metformin a case in point?

2005

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“…In the only randomised control trial, Rachmani et al randomly assigned 393 type 2 diabetics with a serum creatinine of 130-200 μmol/L to continue or stop metformin. 66 A close correlation between serum creatinine and lactate levels was observed (r=0.78, p<0.001). In other small studies, however, this correlation has not been seen.…”

Section: The Case Against Metformin Use In Ckdmentioning

confidence: 65%

Metformin in advanced chronic kidney disease: are current guidelines overly restrictive?

et al. 2016

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Type 2 diabetes mellitus and chronic kidney disease (CKD) frequently co-exist and the increasing burden of both conditions is a global concern. Metformin is established as the first-line treatment for type 2 diabetes because it is associated with improved cardiovascular outcomes and a reduced risk of hypoglycaemia compared with other treatment options. Patients with CKD may benefit in particular because they are at high risk of both cardiovascular disease and hypoglycaemic episodes. However, the use of metformin is restricted in this population due to the concerns over lactic acidosis. Recent reviews have evaluated this risk and concluded that current guidelines for prescribing metformin in CKD may be too restrictive. This narrative review considers this evidence further, but also examines the strength of evidence that favours the use of metformin in CKD patients. Br J Diabetes 2016;16:168-175

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