A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes recommends
metformin therapy as first-line
therapy along with lifestyle modification to treat
type 2 diabetes mellitus. Despite this recommendation,
metformin may be underutilized due to the fear of
metformin-associated
lactic acidosis and because its use is contraindicated in patients with renal dysfunction. Several studies have attempted to characterize the relationship among plasma
metformin levels, plasma
lactate levels, and
lactic acidosis. However, a causal relationship between
metformin and
lactic acidosis has not been definitively established. In the United States, the estimated rate of
lactic acidosis among diabetic patients treated with
metformin is similar to that of diabetic patients not taking
metformin. Despite specific guidelines advising against prescribing
metformin in renal dysfunction, published reports indicate that
metformin is continued in 25% of patients after the
contraindication is discovered. Individual studies point to a possible correlation between
metformin levels and plasma
lactate levels, but mortality does not appear to correlate with plasma
metformin levels. These results indicate that there may not be a direct relationship between plasma
lactate and
metformin levels.
CONCLUSION: