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Contra‐indications to metformin therapy are largely disregarded
Author(s) -
Holstein A.,
Nahrwold D.,
Hinze S.,
Egberts E. H.
Publication year - 1999
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1046/j.1464-5491.1999.00115.x
Subject(s) - medicine , metformin , discontinuation , diabetes mellitus , atrial fibrillation , heart failure , type 2 diabetes , pediatrics , surgery , endocrinology
Summary 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.