Study of Prevalence of Metformin Associated Lactic Acidosis (MALA) In Patients with Creatinine Clearance More Than 20ml/Min/Per 1.73m2
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 6
Abstract
A common clinical challenge facing all practitioners treating patients with type 2 diabetes mellitus today are the guidelines for metformin contraindicating its use in men and women with serum creatnine concentrations ≥1.5 and ≥ 1.4 mg/dl (≥132 and ≥123 mmol/L),respectively. In a patient tolerating and controlled with this medication should it automatically be discontinued as the creatnine rises beyond these cut points over time? Stopping metformin often results in poorly controlled glycemia. Despite the proven benefits ,metformin remains contraindicated in a large segment of the type 2 diabetic population,largely because of concerns over the rare adverse effect of lactic acidosis. For these reasons ,the drug has been restricted to individuals with normal creatnine levels as a surrogate for renal competence. How many patients are unable to receive this medication on the basis of guidelines which,although well intentioned ,are somewhat arbitrary and outdated based on modern assessments of renal status? Given the current contraindications ,we might consider it a challenge to conduct a new clinical trial to evaluate the use of metformin in individuals with various degrees of impaired renal function,taking into account new criteria for assessing glomerular filtration,attempting to translate creatnine into corresponding eGFR cut points in the context of metformin therapy. The present study was conducted in patients with type 2 diabetes mellitus who attended medical OP or admitted in medical wards in Govt.T.D.Medical college ,Alappuzha in age group 13 years and more old during the period March 2014 to Feb 2015. The ultimate aim was to find the prevalence of lactic acidosis in patients taking metformin with creatnine clearance more than 20ml/min. Objective: To study the prevalence of lactic acidosis in patient taking metformin with creatnine clearance more than 20ml/minute/per1.73m2 . Methodology: The study was conducted under the Department of nephrology,Government T D Medical college,Alappuzha which is a teritiary care hospital in central Kerala,South India.Patients attending the department of General Medicine and Nephrology who satisfied the inclusion criteria were enrolled in the study .All Type 2 DM patients with creatinine clearance above 20ml/minute and on metformin monotherapy and age group of 13 years and above were included. Observations and conclusions: Out of the 102 patients studied, 65 were males and 37 were females.8 of them were <40 years,62 were between 40-60 years age group and 32 were more than 60 years age group. The data analysed showed four cases of metabolic acidosis.The bicarbonate levels were low 21.8,21.0,21.4,21.5 mmol/L and the eGFR values were 22.50,28.56,23.33 and 31.27 ml/min per m2 respectively.Based on our study findings, Metformin use is cautioned and very close monitoring is required when the eGFR falls to <30 and ≥20ml/min per 1.73 m2 and to avoid Metformin use if eGFR< 20ml/min per 1.73m2 .
Authors and Affiliations
Dr Gomathy S, Dr Usha Samuel, Dr Balaprabhan G, Dr Legha R
Keywords
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