Contra-indications to metformin therapy are largely disregarded

Authors: Holstein A.; Nahrwold D.; Hinze S.; Egberts E.-H.

Source: Diabetic Medicine, Volume 16, Number 8, August 1999 , pp. 692-696(5)

Publisher: Wiley-Blackwell

Abstract:

Aims To investigate the current metformin treatment practice and in particular to examine the consideration given to its contraindications.

Methods A cross-sectional analysis of 308 consecutive Type 2 diabetic patients (mean age 66 ± 11.3 years) previously treated with metformin on an outpatient basis and admitted to a German general hospital during the period from 1 January 1995 to 31 May 1998 because of acute disease or in order to optimize their diabetes management. All patients underwent a basic investigation comprising a documentation of their medical history, a physical examination, an electrocardiogram, and an extensive laboratory profile; 34% also had acute coronary angiography.

Results On admission to hospital, 73% of the patients were found to have contra-indications, risk factors, or intercurrent illnesses necessitating discontinuation of metformin; 51% of these patients had several of these conditions. As major contra-indications to metformin, renal impairment was present in 19% of all patients, heart failure in 25%, respiratory insufficiency in 6.5%, and hepatic impairment in 1.3%. The risk factors to metformin included advanced coronary heart disease in 51%, atrial fibrillation in 9.8%, chronic alcohol abuse in 3.3%, advanced peripheral vascular disease in 2%, and pregnancy in 0.7%. As intercurrent illnesses, cerebral ischaemia occurred in 9.8% under metformin treatment and malignancies were diagnosed in 6.5%. The patients with contra-indications or requiring caution to metformin were significantly older and had previously been treated with more cardiovascular medication than those without such reservations (P < 0.001).

Conclusions Despite the considerable risk of lactic acidosis in the majority of patients, no cases were observed.

Keywords: mellitus; lactic acidosis; metformin

Language: English

Document Type: Short communication

Publication date: 1999-08-01

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• In this Subject: Internal Medicine
• By this author: Holstein A. ;  Nahrwold D. ;  Hinze S. ;  Egberts E.-H.

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