Abstract
BackgroundThe metformin label has recently been changed from serum creatinine (sCr)-based to estimated glomerular filtration rate (eGFR)-based indication, which is expected to expand its use for patients with mild renal insufficiency. However, because the sCr level is lower in Asians than in Caucasians at the same level of renal function, this change might not expand metformin use in the Asian population. We investigated the effect of this change among Korean patients with diabetes.MethodsData from the Korean National Health and Nutrition Examination Survey 2009 to 2014 were used and included 4,127 adult patients with diabetes. The metformin eligibility was assessed by the sCr level (1.4 mg/dL for women and 1.5 mg/dL for men) or by eGFR categories (contraindicated, <30; indeterminate, ≥30, <45; likely safe, ≥45 mL/min/1.73 m2) calculated by various eGFR equations including MDRD equation. We designated the ‘expanding’ and ‘contracting’ population as those who are likely safe according to eGFR among sCr-ineligible patients and those contraindicated according to eGFR among sCr-eligible patients, respectively. Results were weighted to the whole Korean adult population.ResultsAll eGFR equations showed expansion in the population for whom metformin is likely safe, ranging from 14.3% to 19.9% of the sCr-ineligible population. With the MDRD equation, the expanding population was 15,264 (15.8%) and the contracting population was 0 (0.0%). Male sex and younger age were significantly associated with the expanding population.ConclusionsContrary to our concern, prescribing metformin according to eGFR substantially expanded the indication of its use among the Korean diabetic patients.
Highlights
Metformin, a biguanide, was first introduced to clinical practice in the 1950s and the drug’s benefits are supported by numerous clinical studies
The metformin label has recently been changed from serum creatinine-based to estimated glomerular filtration rate-based indication, which is expected to expand its use for patients with mild renal insufficiency
Contrary to our concern, prescribing metformin according to estimated glomerular filtration rate (eGFR) substantially expanded the indication of its use among the Korean diabetic patients
Summary
A biguanide, was first introduced to clinical practice in the 1950s and the drug’s benefits are supported by numerous clinical studies. Because metformin is mainly eliminated through the kidney [4], it was believed that decreased renal function followed by accumulation of the drug might result in lactic acidosis. Metformin has been contraindicated among patients with renal insufficiency as indicated by serum creatinine (sCr) ! On the basis of these findings, it was suggested that lactic acidosis was not significantly associated with metformin [10], and even if the complication occurred, fatality was relatively less than with other drugs [11]. The metformin label has recently been changed from serum creatinine (sCr)-based to estimated glomerular filtration rate (eGFR)-based indication, which is expected to expand its use for patients with mild renal insufficiency. We investigated the effect of this change among Korean patients with diabetes
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