Contra-indications to metformin therapy are largely disregarded

被引:106
作者
Holstein, A [1 ]
Nahrwold, D [1 ]
Hinze, S [1 ]
Egberts, EH [1 ]
机构
[1] Klinkum Lippe, Dept Med 1, D-32756 Detmold, Germany
关键词
diabetes mellitus; lactic acidosis; metformin;
D O I
10.1046/j.1464-5491.1999.00115.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 I 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.
引用
收藏
页码:692 / 696
页数:5
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