Use of Metformin in Patients with Kidney and Cardiovascular Diseases

Klachko, David M.; Whaley‐Connell, Adam

doi:10.1159/000327151

Cited by 30 publications

(24 citation statements)

References 105 publications

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“…In addition, the UKPDS recruited individuals with newly diagnosed T2DM, and patients with cardiac or renal disease were excluded, as in most other clinical trials. Therefore, the risk-benefit ratio may be more questionable in a routine population with kidney and cardiovascular (CV) disease because of a higher risk of lactic acidosis [14].…”

Section: Introductionmentioning

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

151

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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

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Section: Introductionmentioning

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

151

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“…1) In contrast to other oral antidiabetic drugs, metformin is not associated with a risk of hypoglycemia. [2][3][4] In addition, metformin reduces the long-term incidence of macrovascular complications in type 2 diabetes mellitus, especially among overweight patients. 2,5,6) The most serious adverse event that has been observed during metformin use is lactic acidosis, which is characterized by an elevated blood lactate concentration (>5 mmol/L), decreased blood pH (<7.…”

mentioning

confidence: 99%

Investigation of Risk Factors Affecting Lactate Levels in Japanese Patients Treated with Metformin

Yokoyama

Tsuji

Hiraoka

et al. 2016

Biological & Pharmaceutical Bulletin

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Metformin is a biguanaide antidiabetic drug used worldwide, and its effectiveness and benefits have already been established. However, the safety of high doses of metformin in Japanese patients, especially in elderly patients with a decreased renal function, remains unclear. Among the side effects of metformin, lactate acidosis is the most problematic due to a high mortality rate. Therefore, we assessed plasma lactate levels in metformin-treated patients to identify independent risk factors for hyperlactemia. 290 outpatients receiving various doses of metformin at our hospital were enrolled between March and July 2014. Serum electrolytes, Cre (creatinine), BUN (blood urea nitrogen), UA (uric acid), HbA1c (hemoglobin A1c), and lactate levels were investigated. Lactate levels did not significantly differ between the elderly (≥75 years) and non-elderly (<75 years) groups. Patients in the elderly group had a significantly lower daily metformin dose and estimated glomerular filtration rate (eGFR), compared with the non-elderly group (both p<0.005). Between with and without hyperlactemia groups, no significant differences were observed in either Cre or age. On the other hand, patients with hyperlactemia had a significantly higher dose of metformin than those without hyperlactemia (p<0.05). In this study, we found that old age and mildly impaired kidney function were not associated with increased lactate levels, and that a higher dose of metformin may be an independent risk factor for elevated lactate levels in Japanese patients.

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“…On day one of admission the major concern for physician was to deal with the patient's cardiovascular complication. As the patient was diabetic, physician continued the metformin to regulate blood sugar level as it has been reported to be the safest drug to control sugar level in CVS disorder, [16]. For the infection, physician prescribed ceftriaxone along with diclofenac sodium and cleared the infected wound from pus and applied duoderum dressing: a standard diabetic foot ulcers (DFU) dressing [17,18].…”

Section: Discussionmentioning

confidence: 99%

Complications Associated with Diabetes: A Case Study

Butt¹,

Tipu²,

Malik³

et al. 2017

Natl. j. health sci.

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Background:The current study has focused on the complications arising in a patient due to diabetes mellitus and how the patient's quality of life has been affected. The most feared complication of the disease is loss of lower limb due to infection and major cardiovascular complications.Objectives: Management of a patient with diabetes and cardiovascular complication with history of tuberculosis is studied along with antimicrobial interventions for curing the ulcer and reducing risk of amputation. Cardiovascular complication, one of the co-morbidity of diabetes, was also managed. Methods:After selection of the patient, consent from patient and approval from relevant authority were obtained, patient was kept under observation for a week.Case Presentation: Patient was admitted with complaints of: shortness of breath, palpitation, exertional dyspnea and a spreading right shin discharging foot ulcer. Conclusion:Patient was treated with antibiotics and ionotropic agent and indicated better rate of prognosis.

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Use of Metformin in Patients with Kidney and Cardiovascular Diseases

Cited by 30 publications

References 105 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

Investigation of Risk Factors Affecting Lactate Levels in Japanese Patients Treated with Metformin

Complications Associated with Diabetes: A Case Study

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