UF Health Diabetes Spotlight
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At a Glance: Redefining Guidelines for Metformin Rx
Although clinical trial data are lacking to support the use of metformin in diabetes patients with renal disease, evidence suggests some patients diagnosed with both type 2 diabetes and kidney disease may benefit from adding this medication.
Peter Stacpoole, MD, a Professor of Medicine, Biochemistry and Molecular Biology in the UF College of Medicine, has focused much of his three decades of research work at the University of Florida on the causes and treatment of mitochondrial diseases and lactic acidosis — a rare, life-threatening, hereditary condition in which the body fails to metabolize glucose effectively. His work has been fundamental to the understanding the natural history and course of this serious health condition; authoring publications on the subject which have appeared in the American Journal of Medicine and World Health Organization among others.
Lactic acidosis (LA) can be a primary complication of regular intense workout exercises. Cases of LA in individuals suffering from certain types of cancers, AIDS, and kidney failure are also well-documented. In rare cases, patients with type 2 diabetes who take metformin are noted to have developed the condition (0.03 cases per 1,000 patient years). As a result, the FDA cautions against the use of metformin in patients with diabetes who are at risk for/or have been diagnosed with renal diseases, alcoholism, and a number of other conditions.
Dr. Stacpoole and colleagues are re-evaluating those guidelines; citing in several position papers that at time of diagnosis, most patients with confirmed LA have multiple potential causes for this condition which may not stem from metformin use, and that extending the guidelines for clinical use of the medication in some additional patient populations with type 2 diabetes and kidney disease may be beneficial.
Extending outwards from its traditional use to help treat and manage diabetes, metformin is being studied in clinical research trials nationwide, including many emanating from UF Health, as an investigational drug to help assist in the treatment of certain types of cancers, neurogenerative diseases, and Alzheimer’s disease. Results from these studies may further confirm the efficacy of prescribing metformin in a broader patient network.
Patients in whom it would make the most clinical sense to extend the current guidelines for are those diagnosed with diabetes who are in an emergency room setting. Developing prospective safety studies that evaluate the role of metformin in Type 2 diabetes patients who have moderate renal insufficiency is something Dr. Stacpoole notes, “has not yet been done, but could be addressed.”
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