Diabetes Care, Vol 21, Issue 10 1659-1663, Copyright © 1998 by American Diabetes Association

ARTICLES

Lactic acidosis rates in type 2 diabetes

JB Brown, K Pedula, J Barzilay, MK Herson and P Latare
Kaiser Permanente Center for Health Research, Portland, Oregon 97227-1098, USA. brownjon@chr.mts.kpnw.org

OBJECTIVE: To provide a context for the interpretation of lactic acidosis risk among patients using metformin, we measured rates of lactic acidosis in patients with type 2 diabetes before metformin was approved for use in the U.S. RESEARCH DESIGN AND METHODS: Using electronic databases of hospital discharge diagnoses and laboratory results maintained by a large, nonprofit health maintenance organization (HMO). we identified possible lactic acidosis events in three geographically and racially diverse populations with type 2 diabetes. We then reviewed hard-copy clinical records to confirm and describe each event and determine its likely cause(s). RESULTS: From >41.000 person-years of experience, we found four confirmed, three possible, and three borderline cases of lactic acidosis. In each case, we identified at least one severe medical condition that could have caused the acidosis. The annual confirmed event rate is similar to published rates of metformin-associated lactic acidosis. CONCLUSIONS: Lactic acidosis occurs regularly, although infrequently, among persons with type 2 diabetes, at rates similar to its occurrence among metformin users. The medical conditions with which both metformin-associated and naturally occurring lactic acidosis co-occur are also its potential causes. The observed association between metformin and lactic acidosis may be coincidental rather than causal. This possibility merits further study
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				V. Ashall and T. Dawes Metformin and lactic acidosis Br. J. Anaesth., December 1, 2008; 101(6): 876 - 877. [Full Text] [PDF]

				M. Bodmer, C. Meier, S. Krahenbuhl, S. S. Jick, and C. R. Meier Metformin, Sulfonylureas, or Other Antidiabetes Drugs and the Risk of Lactic Acidosis or Hypoglycemia: A nested case-control analysis Diabetes Care, November 1, 2008; 31(11): 2086 - 2091. [Abstract] [Full Text] [PDF]

				S. Bolen, L. Feldman, J. Vassy, L. Wilson, H.-C. Yeh, S. Marinopoulos, C. Wiley, E. Selvin, R. Wilson, E. B. Bass, et al. Systematic Review: Comparative Effectiveness and Safety of Oral Medications for Type 2 Diabetes Mellitus Ann Intern Med, September 18, 2007; 147(6): 386 - 399. [Abstract] [Full Text] [PDF]

				A A Tahrani, G I Varughese, J H Scarpello, and F W F Hanna Metformin, heart failure, and lactic acidosis: is metformin absolutely contraindicated? BMJ, September 8, 2007; 335(7618): 508 - 512. [Full Text] [PDF]

				A. I. Duncan, C. G. Koch, M. Xu, M. Manlapaz, B. Batdorf, G. Pitas, and N. Starr Recent Metformin Ingestion Does Not Increase In-Hospital Morbidity or Mortality After Cardiac Surgery Anesth. Analg., January 1, 2007; 104(1): 42 - 50. [Abstract] [Full Text] [PDF]

				R. I. Misbin Evaluating the Safety of Diabetes Drugs: Perspective of a Food and Drug Administration insider Diabetes Care, October 1, 2005; 28(10): 2573 - 2576. [Full Text] [PDF]

				P. J. Fall and H. M. Szerlip Lactic Acidosis: From Sour Milk to Septic Shock J Intensive Care Med, September 1, 2005; 20(5): 255 - 271. [Abstract] [PDF]

				J. McCormack, K. Johns, and H. Tildesley Metformin's contraindications should be contraindicated Can. Med. Assoc. J., August 30, 2005; 173(5): 502 - 504. [Full Text] [PDF]

				D. R. Cryer, S. P. Nicholas, D. H. Henry, D. J. Mills, and B. V. Stadel Comparative Outcomes Study of Metformin Intervention Versus Conventional Approach The COSMIC Approach Study Diabetes Care, March 1, 2005; 28(3): 539 - 543. [Abstract] [Full Text] [PDF]

				R. I. Misbin The Phantom of Lactic Acidosis due to Metformin in Patients With Diabetes Diabetes Care, July 1, 2004; 27(7): 1791 - 1793. [Full Text] [PDF]

				S. R. Salpeter, E. Greyber, G. A. Pasternak, and E. E. Salpeter Risk of Fatal and Nonfatal Lactic Acidosis With Metformin Use in Type 2 Diabetes Mellitus: Systematic Review and Meta-analysis Arch Intern Med, November 24, 2003; 163(21): 2594 - 2602. [Abstract] [Full Text] [PDF]

				C.M.B. Edwards, M.A. Barton, J. Snook, M. David, V.H.F. Mak, and T.A. Chowdhury Metformin-associated lactic acidosis in a patient with liver disease QJM, April 1, 2003; 96(4): 315 - 316. [Full Text] [PDF]

				D.-S. Wang, H. Kusuhara, Y. Kato, J. W. Jonker, A. H. Schinkel, and Y. Sugiyama Involvement of Organic Cation Transporter 1 in the Lactic Acidosis Caused by Metformin Mol. Pharmacol., April 1, 2003; 63(4): 844 - 848. [Abstract] [Full Text] [PDF]

				G C Jones, J P Macklin, and W D Alexander Contraindications to the use of metformin BMJ, January 4, 2003; 326(7379): 4 - 5. [Full Text] [PDF]

				J. K Khan, M. Pallaki, S. R Tolbert, and T. R Hornick Lactic Acidemia Associated with Metformin Ann. Pharmacother., January 1, 2003; 37(1): 66 - 69. [Abstract] [Full Text] [PDF]

				R. J Sigal Review: metformin does not increase fatal or non-fatal lactic acidosis or blood lactate concentrations in type 2 diabetes mellitus Evid. Based Med., November 1, 2002; 7(6): 176 - 176. [Full Text] [PDF]

				R. Gupta and M. A. Bettmann Use of Intravenous Contrast Agents in Patients Receiving Metformin * Dr Bettmann responds: Radiology, October 1, 2002; 225(1): 311 - 312. [Full Text] [PDF]

				A. T. Calabrese, K. C. Coley, S. V. DaPos, D. Swanson, and R. H. Rao Evaluation of Prescribing Practices: Risk of Lactic Acidosis With Metformin Therapy Arch Intern Med, February 25, 2002; 162(4): 434 - 437. [Abstract] [Full Text] [PDF]

				J. H. Scarpello Review: Optimal dosing strategies for maximising the clinical response to metformin in type 2 diabetes The British Journal of Diabetes & Vascular Disease, August 1, 2001; 1(1): 28 - 36. [Abstract] [PDF]