Evaluation of Prescribing Practices

Calabrese, Amy T.; Coley, Kim C.; DaPos, Stacey V.; Swanson, Dennis P.; Rao, R. Govinda

doi:10.1001/archinte.162.4.434

Cited by 145 publications

(23 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although we did not include data to assess the incidence of ICU admission in metformin users and non-users, we do not believe that there is any major difference as the prevalence of metformin use was very similar in our study compared with the prevalence in type 2 diabetics included in a population-based survey in 2006 [43]. Metformin is contraindicated in patients with severe congestive heart failure or with severe liver or renal disease, and should be used with caution in patients aged 80 years or older and in patients with chronic obstructive pulmonary disease [1,44,45]. We adjusted for age and diagnosed lifestyle-related conditions, such as chronic pulmonary disease, obesity, alcohol-related disease, and cardiovascular disease.…”

Section: Discussionmentioning

confidence: 84%

Preadmission metformin use and mortality among intensive care patients with diabetes: a cohort study

et al. 2013

View full text Add to dashboard Cite

IntroductionMetformin has anti-inflammatory and anti-thrombotic effects that may improve the outcome of critical illness, but clinical data are limited. We examined the impact of preadmission metformin use on mortality among intensive care unit (ICU) patients with type 2 diabetes.MethodsWe conducted this population-based cohort study among all persons admitted to the 17 ICUs in Northern Denmark (population approximately 1.8 million). We focused on all patients with type 2 diabetes who were admitted to the ICUs between January 2005 and December 2011. Through individual-level linkage of population-based medical databases, type 2 diabetes was identified using a previously validated algorithm including hospital diagnoses, filled prescriptions for anti-diabetic drugs, and elevated HbA1c levels. Metformin use was identified by filled prescriptions within 90 days before admission. Covariates included surgery, preadmission morbidity, diabetes duration, and concurrent drug use. We computed 30-day mortality and hazard ratios (HRs) of death using Cox regression adjusted for covariates, both overall and after propensity score matching.ResultsWe included 7,404 adult type 2 diabetes patients, representing 14.0% of 52,964 adult patients admitted to the ICUs. Among type 2 diabetes patients, 1,073 (14.5%) filled a prescription for metformin as monotherapy within 90 days before admission and 1,335 (18.0%) received metformin in combination with other anti-diabetic drugs. Thirty-day mortality was 17.6% among metformin monotherapy users, 17.9% among metformin combination therapy users, and 25.0% among metformin non-users. The adjusted HRs were 0.80 (95% confidence interval (CI): 0.69, 0.94) for metformin monotherapy users and 0.83 (95% CI: 0.71, 0.95) for metformin combination therapy users, compared to non-users. Propensity-score-matched analyses yielded the same results. The association was evident across most subgroups of medical and surgical ICU patients, but most pronounced in elderly patients and in patients with well-controlled diabetes. Former metformin use was not associated with decreased mortality.ConclusionsPreadmission metformin use was associated with reduced 30-day mortality among medical and surgical intensive care patients with type 2 diabetes.

show abstract

Section: Discussionmentioning

confidence: 84%

Preadmission metformin use and mortality among intensive care patients with diabetes: a cohort study

et al. 2013

View full text Add to dashboard Cite

show abstract

“…In a U.S. study (42) performed in the primary care practice setting, 4.5% of patients treated with metformin had creatinine levels >1.4 and 1.5 mg/dL in women and men, respectively. Two other studies (38,40) of sicker patients admitted to hospitals in Germany and the U.S. confirmed high frequency of metformin use despite various contraindications (73 and 27%, respectively).…”

Section: Current Use Of Metformin In Ckdmentioning

confidence: 76%

Use of Metformin in the Setting of Mild-to-Moderate Renal Insufficiency

2011

View full text Add to dashboard Cite

“…11 Interestingly, 41% of patients were continued on metformin therapy despite hospital admissions to cardiology and general medicine services. 15 Perhaps their prescribers agree with data that show that metformin improves cardiovascular outcomes in patients with heart failure. 5,6 This article examines evidence regarding the safety of metformin use in heart failure.…”

mentioning

confidence: 94%

“…Despite the manufacturer's warning 4 against the potential risk of lactic acidosis, many physicians prescribe metformin in patients with existing CHF. 15 In one report, 73% of metformin users had at least one contraindication to its use at hospitalization, with 25% having CHF. 11 Interestingly, 41% of patients were continued on metformin therapy despite hospital admissions to cardiology and general medicine services.…”

mentioning

confidence: 99%