Is there a risk of fatal or nonfatal lactic acidosis when metformin is used in people with type 2 diabetes mellitus?

2012 ◽  
Author(s):  
William Cayley Jr
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Lactic Acidosis

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

2010 ◽  
Author(s):  
Shelley R Salpeter ◽  
Elizabeth Greyber ◽  
Gary A Pasternak ◽  
Edwin E Salpeter (posthumous)
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Lactic Acidosis

scholarly journals A case of type 2 diabetes mellitus with metformin-associated lactic acidosis initially presenting the appearance of a sulfonylurea-related hypoglycemic attack

2016 ◽  
Vol 4 (1) ◽  
pp. 123-126 ◽  
Author(s):  
Kota Nishihama ◽  
Kanako Maki ◽  
Yuko Okano ◽  
Rei Hashimoto ◽  
Yasuhiro Hotta ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Lactic Acidosis ◽  
Hypoglycemic Attack

scholarly journals HYPERLACTATEMIA IN TREATMENT OF DIABETES TYPE 2 BY METFORMIN

2020 ◽  
Vol 23 (2) ◽  
pp. 201-205
Author(s):  
I. V. Tereshchenko
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Lactic Acid ◽  
Lactic Acidosis ◽  
Blood Lactate ◽  
Clinical Manifestations ◽  
Diabetes Type 2 ◽  
Oxygen Starvation

It was previously found that when it is treated type 2 diabetes mellitus (DM2) by metformin, hyperlactemia does not develop or occurs extremely rarely, and due to concomitant pathology. Clinicians usually do not monitor blood lactate levels. Goal: to analyze the frequency of hyperlactatemia in patients with DM2, its possible causes and role in this of metformin, clinical manifestations, ways of elimination and prevention. We observed in the dynamics of 38 patients with DM2 receiving metformin in doses of 1500–3000 mg / day. All patients were tested the level of lactate in the blood. Hyperlactatemia was detected in 6 cases (12.8% of patients), of which two patients (5.3%) showed lactic acidosis: the blood lactate level of them was 4.0 μmol/L and 4.6 μmol/L. A correlation between the level of lactic acid and the dose of metformin has not been established. All observed patients had polymorbidity and compelled polypharmacy. Hypothyroidism was observed in 42.1% of patients; in patients with lactic acidosis hypothyroidism was decompensated, i.e. it was chronic oxygen starvation of tissues. Conclusion: Observations confirmed that treatment of DM2 with metformin is rarely complicated by lactic acidosis and even moderate hyperlactatemia. Complications of diabetes, concomitant pathology and compelled polypharmacy, including metformin, disrupt the metabolism of lactic acid, its elimination, utilization in gluconeogenesis processes; in ≈12.8% of cases, the level of lactate in the blood rises. The risk of lactic acidosis, i.e. death threat occurs in ≈5.3% of patients. Along with the etiological factors of lactic acidosis widely presented in publications in patients with type 2 diabetes mellitus, in ≈42.1% of cases, lactate accumulation is promoted by hypothyroidism, the decompensation of which creates chronic oxygen starvation of tissues. To check periodically the level of lactic acid and monitor the function of the thyroid gland it is necessary in all patients with DM2, even if they are not treated with metformin.

scholarly journals Metformin use in patients with type 2 diabetes mellitus and chronic kidney disease: An evidence-based review

2021 ◽  
Vol 50 (2) ◽  
pp. 159-170
Author(s):  
Felicia Clara JH Tan ◽  
Seng Bin Ang ◽  
Yong Mong Bee
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Lactic Acidosis ◽  
Cohort Studies ◽  
Case Series ◽  
Stage 4 ◽  
Ckd Stage ◽  
All Cause Mortality

Introduction: Practice guidelines advise caution on the use of metformin in patients with type 2 diabetes mellitus with chronic kidney disease (CKD). This review aims to examine the evidence for the benefits and risks of metformin use in patients with T2DM and CKD. Methods: The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and PubMed were searched; the references of selected papers were hand searched. Systematic reviews, randomised controlled trials, cohort studies, case series and case-control studies were included. The full text of selected articles was reviewed. The outcomes studied were all-cause mortality, cardiovascular complications, lactic acidosis and worsening of renal function. Recommendations were graded according to the Scottish Intercollegiate Guidelines Network system. Results: A total of 139 unique articles were identified, 14 of which met the inclusion criteria and were selected for full-text review. Four cohort studies reported an association between metformin use and improved all-cause mortality in CKD stage 4 and better. Two cohort studies reported improved cardiovascular outcomes with metformin use. Four cohort studies, 1 case series and 1 case-control study reported no significant association between metformin use and an increased risk of lactic acidosis in CKD. There is a moderate level of evidence to support reduced mortality, improved cardiovascular outcomes and a low risk of lactic acidosis with metformin use in patients with T2DM and with CKD stage 4 and above. Conclusion: Existing recommendations to restrict metformin use in diabetes patients with CKD need to be reviewed in light of emerging evidence supporting its overall benefits in these patients. Keywords: Chronic renal insufficiency, metformin, type 2 diabetes mellitus

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