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Association between Metformin Use and Risk of Lactic Acidosis or Elevated Lactate Concentration in Type 2 Diabetes

Authors
 Eun Young Lee  ;  Sena Hwang  ;  Yong-ho Lee  ;  Seo Hee Lee  ;  Young Mi Lee  ;  Hua Pyong Kang  ;  Eugene Han  ;  Woonhyoung Lee  ;  Byung-Wan Lee  ;  Eun Seok Kang  ;  Bong Soo Cha  ;  Hyun Chul Lee 
Citation
 Yonsei Medical Journal, Vol.58(2) : 312-318, 2017 
Journal Title
 Yonsei Medical Journal 
ISSN
 0513-5796 
Issue Date
2017
MeSH
Acidosis, Lactic/blood ; Acidosis, Lactic/chemically induced* ; Acidosis, Lactic/epidemiology ; Adult ; Aged ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/blood ; Diabetes Mellitus, Type 2/drug therapy* ; Diabetes Mellitus, Type 2/epidemiology ; Female ; Humans ; Hyperlactatemia/blood ; Hyperlactatemia/chemically induced* ; Hyperlactatemia/epidemiology ; Hypoglycemic Agents/adverse effects* ; Hypoglycemic Agents/blood ; Hypoglycemic Agents/therapeutic use ; Incidence ; Lactic Acid/blood ; Male ; Metformin/adverse effects* ; Metformin/blood ; Metformin/therapeutic use ; Middle Aged ; Prevalence ; Regression Analysis ; Renal Insufficiency/epidemiology ; Renal Insufficiency/physiopathology ; Risk Factors
Keywords
Metformin ; diabetes mellitus ; lactate ; lactic acidosis
Abstract
PURPOSE: Metformin can reduce diabetes-related complications and mortality. However, its use is limited because of potential lactic acidosis-associated adverse effects, particularly in renal impairment patients. We aimed to investigate the association of metformin use with lactic acidosis and hyperlactatemia in patients with type 2 diabetes. MATERIALS AND METHODS: This was a cross-sectional study from a tertiary university-affiliated medical center. A total of 1954 type 2 diabetes patients were recruited in 2007-2011, and stratified according to the estimated glomerular filtration rate of 60 mL/min/1.73 m². Lactic acidosis was defined as plasma lactate levels >5 mmol/L and arterial pH <7.35. RESULTS: Metformin was used in 61.4% of the patients with type 2 diabetes mellitus. Plasma lactate levels were not different in the patients with and without metformin use. There was no difference in prevalence of hyperlactatemia and lactic acidosis between the patients with and without metformin use (18.9% vs. 18.7%, p=0.905 for hyperlactatemia and 2.8% vs. 3.3%, p=0.544 for lactic acidosis). Similar results were observed in the patients with estimated glomerular filtration rate <60 mL/min/1.73 m². Most patients with lactic acidosis had at least one condition related to hypoxia or poor tissue perfusion. Multiple regression analysis indicated no association between metformin use and lactic acidosis, whereas tissue hypoxia was an independent risk factor for lactic acidosis [odds ratio 4.603 (95% confidence interval, 1.327-15.965)]. CONCLUSION: Metformin use was not associated with hyperlactatemia or lactic acidosis in patients with type 2 diabetes.
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DOI
10.3349/ymj.2017.58.2.312
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
강은석(Kang, Eun Seok) ORCID logo https://orcid.org/0000-0002-0364-4675
강화평(Kang, Huapyong) ORCID logo https://orcid.org/0000-0003-1790-0809
이병완(Lee, Byung Wan) ORCID logo https://orcid.org/0000-0002-9899-4992
이용호(Lee, Yong Ho) ORCID logo https://orcid.org/0000-0002-6219-4942
이현철(Lee, Hyun Chul)
차봉수(Cha, Bong Soo) ORCID logo https://orcid.org/0000-0003-0542-2854
한유진(Han, Eu Gene)
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/154197
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