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      Association of Metformin Use With Risk of Lactic Acidosis Across the Range of Kidney Function : A Community-Based Cohort Study

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          Abstract

          Approximately 1 million patients in the United States with type 2 diabetes mellitus and mild-to-moderate kidney disease do not receive guideline-directed therapy with metformin. This may reflect uncertainty regarding the risk of acidosis in patients with chronic kidney disease.

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          Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease.

          Merlin Thomas, Mark E. Cooper, Paul Zimmet (2016)
          Chronic kidney disease (CKD) is a common comorbidity in patients with type 2 diabetes mellitus (T2DM) and both conditions are increasing in prevalence. CKD is estimated to affect ∼50% patients with T2DM globally, and its presence and severity markedly influences disease prognosis. CKD is more common in certain patient populations, including the elderly, those with youth-onset diabetes mellitus, those who are obese, certain ethnic groups, and disadvantaged populations. These same settings have also seen the greatest increase in the prevalence of T2DM, as exemplified by the increasing prevalence of T2DM in low-to- middle income countries. Patients from low-to-middle income countries are often the least able to deal with the burden of T2DM and CKD and the health-care facilities of these countries least able to deal with the demand for equitable access to renal replacement therapies. The increasing prevalence of younger individuals with T2DM, in whom an accelerated course of complications can be observed, further adds to the global burden of CKD. Paradoxically, improvements in cardiovascular survival in patients with T2DM have contributed to patients surviving longer, allowing sufficient time to develop renal impairment. This Review explores how the changing epidemiology of T2DM has influenced the prevalence and incidence of associated CKD across different populations and clinical settings.
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            Diabetes Medications as Monotherapy or Metformin-Based Combination Therapy for Type 2 Diabetes: A Systematic Review and Meta-analysis.

            Nisa M. Maruthur, Eva Tseng, Susan Hutfless … (2016)
            Clinicians and patients need updated evidence on the comparative effectiveness and safety of diabetes medications to make informed treatment choices.
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              Metformin in patients with type 2 diabetes and kidney disease: a systematic review.

              Silvio E Inzucchi, Kasia Lipska, Helen Mayo … (2014)
              Metformin is widely viewed as the best initial pharmacological option to lower glucose concentrations in patients with type 2 diabetes mellitus. However, the drug is contraindicated in many individuals with impaired kidney function because of concerns of lactic acidosis.
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                Author and article information

                Journal
                Title: JAMA Internal Medicine
                Abbreviated Title: JAMA Intern Med
                Publisher: American Medical Association (AMA)
                ISSN (Print): 2168-6106
                Publication date Created: July 01 2018
                Publication date (Print): July 01 2018
                Volume: 178
                Issue: 7
                Page: 903
                Affiliations
                [1 ]Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
                [2 ]Division of Nephrology, Monash Medical Centre, Clayton, Australia
                [3 ]Department of Medicine, Johns Hopkins University, Baltimore, Maryland
                [4 ]Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
                [5 ]Kidney Health Research Institute, Geisinger Health System, Danville, Pennsylvania
                Article
                DOI: 10.1001/jamainternmed.2018.0292
                PMC ID: 6145716
                PubMed ID: 29868840
                SO-VID: 4c890954-e25f-4b68-a56a-6cb9b6be0695
                Copyright © © 2018
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