Metformin Use in Patients With Historical Contraindications

Editorials7 February 2017Metformin Use in Patients With Historical ContraindicationsKasia J. Lipska, MD, MHSKasia J. Lipska, MD, MHSFrom Yale School of Medicine, New Haven, Connecticut.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-2712 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Patients with type 2 diabetes rarely have just 1 chronic condition to manage (1). Some comorbid conditions, such as kidney disease, heart failure, and liver dysfunction, greatly reduce the number of drugs that can be used safely to lower blood glucose levels. As a result, patients with these conditions often end up on medications that increase the risk for hypoglycemia and weight gain (sulfonylureas or insulin), result in a high treatment burden (insulin), or substantially increase the cost of treatment (all newer, branded products). For these patients, a safe and inexpensive oral agent, minimally disruptive to their routines, would be ...References1. Piette JD, Kerr EA. The impact of comorbid chronic conditions on diabetes care. Diabetes Care. 2006;29:725-31. [PMID: 16505540] CrossrefMedlineGoogle Scholar2. Misbin RI, Green L, Stadel BV, Gueriguian JL, Gubbi A, Fleming GA. Lactic acidosis in patients with diabetes treated with metformin [Letter]. N Engl J Med. 1998;338:265-6. [PMID: 9441244] CrossrefMedlineGoogle Scholar3. Inzucchi SE, Masoudi FA, McGuire DK. Metformin in heart failure [Letter]. Diabetes Care. 2007;30:e129. [PMID: 18042738] CrossrefMedlineGoogle Scholar4. Lipska KJ, Flory JH, Hennessy S, Inzucchi SE. Citizen petition to the US Food and Drug Administration to change prescribing guidelines: the metformin experience. Circulation. 2016;134:1405-1408. [PMID: 27799258] CrossrefMedlineGoogle Scholar5. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359:1577-89. [PMID: 18784090] doi:10.1056/NEJMoa0806470 CrossrefMedlineGoogle Scholar6. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352:854-65. [PMID: 9742977] CrossrefMedlineGoogle Scholar7. Crowley MJ, Diamantidis CJ, McDuffie JR, Cameron CB, Stanifer JW, Mock CK, et al. Clinical outcomes of metformin use in populations with chronic kidney disease, congestive heart failure, or chronic liver disease. A systematic review. Ann Intern Med. 2017;166:191-200. doi:10.7326/M16-1901 LinkGoogle Scholar8. Bennett WL, Maruthur NM, Singh S, Segal JB, Wilson LM, Chatterjee R, et al. Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations. Ann Intern Med. 2011;154:602-13. [PMID: 21403054]. doi:10.7326/0003-4819-154-9-201105030-00336 LinkGoogle Scholar9. Zinman B, Lachin JM, Inzucchi SE. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes [Letter]. N Engl J Med. 2016;374:1094. [PMID: 26981940] doi:10.1056/NEJMc1600827 CrossrefMedlineGoogle Scholar10. U.S. Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research (CDER). Guidance for Industry: Diabetes Mellitus—Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes, December 2008. Accessed at www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation/guidances/ucm071627.pdf on 8 November 2016. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Yale School of Medicine, New Haven, Connecticut.Financial Support: From the National Institute on Aging and the American Federation of Aging Research through a Paul Beeson Career Development Award (K23AG048359) and the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342).Disclosures: Dr. Lipska reports grants from the National Institute on Aging and financial support from the Centers for Medicaid and Medicare Services to develop and maintain publicly reported quality measures, outside the submitted work. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2712.Corresponding Author: Kasia J. Lipska, MD, Yale School of Medicine, Department of Internal Medicine, Section of Endocrinology, PO Box 208020, New Haven, CT 06520; e-mail, kasia.[email protected]edu.Current Author Addresses: Dr. Lipska: Yale School of Medicine, Department of Internal Medicine, Section of Endocrinology, PO Box 208020, New Haven, CT 06520.This article was published at Annals.org on 3 January 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoClinical Outcomes of Metformin Use in Populations With Chronic Kidney Disease, Congestive Heart Failure, or Chronic Liver Disease Matthew J. Crowley , Clarissa J. Diamantidis , Jennifer R. McDuffie , C. Blake Cameron , John W. Stanifer , Clare K. Mock , Xianwei Wang , Shuang Tang , Avishek Nagi , Andrzej S. Kosinski , and John W. Williams Jr. Metrics Cited byMetformin Use Is Associated with Fewer Complications in Patients with Type-2 Diabetes Undergoing Total Knee ArthroplastyCardiovascular events and mortality among type 2 diabetes mellitus patients newly prescribed first-line blood glucose-lowering drugs monotherapies: A population-based cohort study in the Catalan electronic medical record database, SIDIAP, 2010-2015Conventional and Alternative Mesenchymal Stem Cell Therapies for the Treatment of DiabetesDoes Metformin Have an Effect on Stent Patency RatesChanges in the Prescription of Glucose‐Lowering Medications in Patients With Type 2 Diabetes Mellitus After a Cardiovascular Event: A Call to Action From the DATAFILE StudyMetformin: A Candidate Drug for Renal Diseases 7 February 2017Volume 166, Issue 3Page: 225-226KeywordsEstimated glomerular filtration rateFood and Drug AdministrationGlucoseHeart failureHypoglycemiaKidneysLiver diseasesMortalityRenal diseasesWeight gain ePublished: 3 January 2017 Issue Published: 7 February 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. 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