Video: When Should Metformin be Omitted?

Guidelines say metformin should be stopped where there is acute kidney injury or risk of renal compromise. Now there is evidence to support those recommendations.

There is a dearth of evidence to support the omission of metformin during illnesses that may increase the risk of acute kidney injury (AKI), a need that led the current authors to examine the relationship between AKI, lactate concentrations, and risk of lactic acidosis in individuals taking metformin.

Their paper, recently published in the journal Diabetes, Obesity, and Metabolism, reported results of a population-based case control study of metformin use, and lactic acidosis in patients with type 2 diabetes.

The study found a definite association between metformin, lactate accumulation, and the development of lactic acidosis-in fact, individuals treated with metformin were more than twice as likely to develop the condition vs non-metformin treated persons with or without diabetes. The association was strongest in those patients with AKI.

The authors concluded the evidence supports the recommendation to omit metformin in any disease state that may cause acute renal insuffiency.

Source: Connelly PJ, Lonergan M, Soto-Pedre E, et al. Acute kidney injury, plasma lactate concentrations and lactic acidosis in metformin users: A GoDarts study. Diabetes Obese Metab. 2017;19:1579–1586.