To compare the chronic hyperlactatemic effect of
phenformin and
metformin, we performed a double-blind study in 10 non
insulin-dependent diabetics without any other known hyperlactatemic condition. After a pre-study period, each patient was allocated to a 6-month treatment with
phenformin (50 mg bid) or
metformin (850 mg bid) in random sequence.
Body weight values were not significantly different between
phenformin and
metformin. Diabetic control was significantly (p less than 0.001) improved by both
biguanides versus pre-study, but was the same during
metformin and
phenformin: HbAI = 13.8 +/- 0.3 SEM% during pre-study 9.7 +/- 0.2% during
phenformin, 10.2 +/- 0.2% during
metformin. Mean values of plasma
lactate during
metformin were significantly lower versus
phenformin (1.30 +/- 0.05 vs 1.64 +/- 0.05 mmol/l, p less than 0.001). Mean values of plasma
lactate/
pyruvate ratio during
metformin were significantly lower versus
phenformin (16.92 +/- 0.59 vs 22.65 +/- 0.87, p less than 0.001), but not versus pre-study (16.19 +/- 0.51). These results indicate that: 1) during a 6-month treatment with a diabetic control of similar degree
phenformin produces a significantly higher hyperlactatemic effect vs
metformin; 2)
metformin treatment is associated with less impairment of intracellular redox state versus
phenformin, and therefore should be considered advantageous in the long-term treatment of non
insulin-dependent diabetics.