Association between Metformin Use and Risk of Lactic Acidosis or Elevated Lactate
Concentration in Type 2 Diabetes
#MMPMID28120561
Lee EY
; Hwang S
; Lee YH
; Lee SH
; Lee YM
; Kang HP
; Han E
; Lee W
; Lee BW
; Kang ES
; Cha BS
; Lee HC
Yonsei Med J
2017[Mar]; 58
(2
): 312-318
PMID28120561
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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 mē. 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 mē. 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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