Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus

Salpeter, Shelley R.; Greyber, Elizabeth; Pasternak, Gary A; Salpeter, E. E.

doi:10.1002/14651858.cd002967

Cited by 69 publications

(18 citation statements)

References 164 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Its predecessor, phenformin, was abandoned due to fatal cases of lactic acidosis. The use of metformin, with adherence to the contraindications and warnings, confirmed its safety in both post-marketing surveillance studies [3,4] and several clinical studies [5,6], where there was no excess risk of lactic acid associated with its use, compared to those not taking any agent. In usual practice, metformin has been widely prescribed for diabetic patients with a known contraindicated condition, but, apparently, no lactic acidosis cases were observed [7,8].…”

Section: Introductionmentioning

confidence: 67%

“…Our small sample size could be an explanation, considering that the pooled incidence of metformin-associated lactic acidosis is 6-8 cases per 100,000 patient-years [6]. In addition, the number of patients considered to have contraindications to metformin use was too small (N = 315) to observe for the event within the time-frame studied.…”

Section: Prevalence Of Metformin Prescribed In Type 2 Diabetes With Amentioning

confidence: 93%

See 1 more Smart Citation

Prescribing metformin in type 2 diabetes with a contraindication: prevalence and outcome

et al. 2009

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 67%

Section: Prevalence Of Metformin Prescribed In Type 2 Diabetes With Amentioning

confidence: 93%

Prescribing metformin in type 2 diabetes with a contraindication: prevalence and outcome

et al. 2009

View full text Add to dashboard Cite

show abstract

“…The incidence of 13.8 cases/year/100,000 metformin-treated diabetics is one of the highest previously reported [5,9,11,23,24,25,26]. However, this discrepancy could be due to the different methods and target of the study (data base screening, definition of lactic acidosis, and definition of MALA as patients undergoing RRT in ICU), or due to the different health policies implemented at that time.…”

Section: Discussionmentioning

confidence: 99%

Metformin-Associated Lactic Acidosis Undergoing Renal Replacement Therapy in Intensive Care Units: A Five-Million Population-Based Study in the North-West of Italy

et al. 2017

View full text Add to dashboard Cite

Background: Metformin-associated lactic acidosis (MALA) is a severe complication of drug administration with significant morbidity and mortality. So far no study in large population areas have examined the incidence, clinical profile and outcome of acute kidney injury (AKI)-MALA patients admitted in intensive care units (ICUs) and treated by renal replacement therapy (MALA-RRT). Methods: Retrospective analysis over a 6-year period (2010-2015) in Piedmont and Aosta Valley regions (5,305,940 inhabitants, 141,174 diabetics treated with metformin) of all MALA-RRT cases. Results: One hundred and seventeen cases of AKI-MALA-RRT were observed (12.04/100,000 metformin treated diabetics, 1.45% of all RRT-ICU patients). Survival rate was 78.3%. The average duration of RRT was 4.0 days at mean dialysis effluent of 977 mL/kg/day. At admission most patients were dehydrated, and experienced shock and oliguria. Conclusion: Our data showed that MALA-RRT is a common complication, needing more prevention. Adopted policy of early, extended, continuous and high efficiency dialysis could contribute to an observed high survival rate. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=471917.

show abstract

“…In patients with renal failure (GFR <60 mL/min), early detection of renal failure after a possibly nephrotoxic abuse is crucial. The use of new biomarkers in urine sample (almost 12 hours after abuse) may supply a quick identification for AKI (25). One logical suggestion for metformin dose is first monitoring of plasma lactate and creatinine at 24 and 48 hours after procedure, and thus stop of metformin if creatinine is increasing (>10%) or lactate exceeds 3.5 mmol.…”

Section: Metformin and Lactic Acidosismentioning

confidence: 99%

Metformin protects renal tubular cells; mechanisms and new concepts

Dorestan¹,

Manzouri²,

Bahadoram³

et al. 2018

J Nephropathol

View full text Add to dashboard Cite

Context:The prevalence of diabetes markedly increased in recent decades. It is well accepted that the risk of morbidity and fatality increases in patients with type 2 diabetes (T2DM). Evidence Acquisition: An electronic search was performed to detect suitable studies, with keywords of metformin, prediabetes, diabetes Mellitus, Gentamicin and lactic acidosis. Results: Metformin (biguanide) is widely used as the first pharmacological option in pre-diabetic subjects and patients with T2DM. Low-cost, long-term effect, low risk of hypoglycemia, and ease in utilization are considered as significant benefits of metformin compared with other therapies. Numerous studies have explored that medicinal intervention particularly metformin administration not only can decrease high blood glucose in patients with T2DM but also can avoid or postpone the beginning of clinical T2DM in pre-diabetic cases. Protective effect of metformin on renal cells by different mechanisms is described here. Gentamicin is an important factor that affects kidney function and structure. Nephrotoxicity is one of the serious side effects of gentamicin (an aminoglycoside antibiotic). Numerous investigation showed the protective effect of metformin against the gentamicin nephrotoxicity. On the other hand, lactic acidosis is known as an uncommon but serious side effect of metformin that should be mentioned. Signs of lactic acidosis are defined by plasma lactate levels higher than 5 mmol/L and pH smaller than 7.4. Conclusions: Different small series and large experimental investigations have discovered the association between metformin and lactic acidosis summarized here. ABSTRACT Implication for health policy/practice/research/medical education:Although metformin is known as the most confident hypoglycemic medicine in patients with chronic kidney disease according to the benefits linked with reduction of metabolic disorder and protection against cardiovascular disease, present recommendations explain that it should be administrated with carefulness in glomerular filtration rate of lower than 60 mL/ min. Other studies suggested an important clinical benefit for diabetes mellitus outcomes particularly myocardial infarction from metformin compared with other oral agents like sulfonylurea agents. Finally, elderly people may be at higher risk for lactic acidosis.

show abstract

Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus

Cited by 69 publications

References 164 publications

Prescribing metformin in type 2 diabetes with a contraindication: prevalence and outcome

Prescribing metformin in type 2 diabetes with a contraindication: prevalence and outcome

Metformin-Associated Lactic Acidosis Undergoing Renal Replacement Therapy in Intensive Care Units: A Five-Million Population-Based Study in the North-West of Italy

Metformin protects renal tubular cells; mechanisms and new concepts

Contact Info

Product

Resources

About