posted 11/13/02
In patients with type-2 diabetes, metformin has been shown to
be safe and effective, negating criteria limiting its use, according to Israeli
researchers.
Patients may be treated with metformin even in cases with mild renal impairment,
cardiac disease, heart failure, and chronic obstructive pulmonary disease.
The researchers note that reports of mortality and lactic acidosis associated
with phenformin stem from research 30 years ago and have led to the restricted
use of metformin, though data about its safety is limited.
In a randomized, prospective trial, Rita Rachmani and colleagues from Sackler
School of Medicine, Tel-Aviv University and Meir Hospital in Kfar-Sava, Israel,
assessed the safety of the continued use of metformin in 393 patients with
type-2 diabetes and serum creatinine levels between 130-220 µmol/l.
In these patients treated with metformin, 266 had coronary heart disease (CHD),
94 had congestive heart failure (CHF), and 91 suffered from chronic obstructive
pulmonary disease (COPD). The patients were assigned to either continue or to
stop metformin. They were followed up for a period of four years.
The results show a significant rise in body mass index and in hemoglobin A1c in
patients who discontinued metformin compared to those who continued treatment.
The researchers detected no case of lactic acidosis during the follow up or any
difference in the values of lactic acid between the two groups. They found a
correlation of lactic acid only with serum creatinine and body mass index.
Both groups had similar microvascular diabetic complications and adverse
cardiovascular events. Cardiovascular death and total mortality were also
identical in both groups of patients.
The authors recommend the continuation of metformin in diabetic patients who
tolerate the drug well and have a serum creatinine levels up to 220 µmol/l.
There is no rationale for stopping the drugs in patients with CHD, CHF, and COPD,
they conclude.
Source: Diabetes In Control Dot Com: European J. Internal Med. 2002; Vol. 13, Issue 7, Pages 428-433.
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