Risk Factors For Lactic Acidosis Research Articles

Risk factors for lactic acidosis with metformin

Risk factors for lactic acidosis with metformin

Risk factors for lactic acidosis with metformin

Risk factors for lactic acidosis with metformin

Diabetes Care for Patients with Peripheral Arterial Disease

The number of diabetics will increase almost 70% in developed countries during the next 20 years: peripheral arterial disease is a common and costly complication. The incidence of cardiovascular disease (mortality and morbidity) due to atherosclerosis, is higher among patients with diabetes than in those without diabetes. Intensive management of diabetes, including glycaemic control, treatment of hypertension and dyslipidemia, as well as nonpharmacological interventions, decreases both micro- and macrovascular complications. Aspirin and clopidogrel have less antiplatelet effect in patients with diabetes. Metformin therapy is considered a risk factor for lactic acidosis if not withdrawn 2 days before angiography, but this risk is extremely low in patients with normal renal function. Peri-operative hyperglycaemia and large fluctuations in plasma glucose increase postoperative mortality and morbidity and careful measures are required to minimise these effects.

A high incidence of nucleoside reverse transcriptase inhibitor (NRTI)-induced lactic acidosis in HIV-infected patients in a South African context.

To determine the incidence of and predisposing risk factors for lactic acidosis in HIV-infected patients on antiretroviral drugs in South Africa. Observational case series. Sinikithemba HIV Clinic, McCord Hospital, Durban. Eight hundred and ninety-one HIV-positive patients on highly active antiretroviral therapy (HAART) during an 18-month period commencing in January 2004. Fourteen cases of lactic acidosis (incidence rate of 19 (95% confidence interval (CI): 9-29) cases per 1,000 person-years of treatment) were reported. All cases were female, with a median age of 36 years and a median weight of 81 kg. The median time on HAART before developing lactic acidosis was 7.5 months and the median peak lactate level was 9.3 mmol/l. All cases were on stavudine (d4T), lamivudine (3TC) and 1 non-NRTI. The case mortality rate was 29% (4 patients). The incidence rate is higher than reported in studies in developed countries. This may be due to d4T, which is recommended as a first-line antiretroviral drug in South Africa. This implication raises the question whether it is an appropriate drug in first-line treatment of patients with predisposing risk factors such as female gender and being overweight.

Do risk factors for lactic acidosis influence dosing of metformin?

Metformin is commonly prescribed to treat type 2 diabetes mellitus, however it is associated with the potentially lethal condition of lactic acidosis. Prescribing guidelines have been developed to minimize the risk of lactic acidosis development, although some suggest they are inappropriate and have created confusion amongst prescribers. The aim of this study was to investigate whether metformin dose was influenced by the presence of risk factors for lactic acidosis. The study was prospective, and retrieved information from patients admitted to hospital who were prescribed metformin at their time of admission. Eighty-three patients were included in the study, 60 of whom had a least one risk factor for lactic acidosis. Of those 60 patients, 78.3% had a dose adjustment, with renal impairment, hepatic impairment, surgery and use of radiological contrast media--the risk factors most likely to result in a dose adjustment. When dose adjustments did occur, metformin was withheld on 88.7% of occasions. Metformin dose was influenced by the presence of risk factors for lactic acidosis, although it was dependent upon the number and particular risk factor/s present.

Risk factors for lactic acidosis in HIV-infected patients treated with nucleoside reverse-transcriptase inhibitors: a case-control study.

A case-control study was undertaken to determine risk factors for lactic acidosis in human immunodeficiency virus-infected patients treated with nucleoside reverse-transcriptase inhibitors (NRTIs). From May 1996 to June 2000, 9 patients with lactic acidosis (defined as a plasma lactic acid level of >5 mM and plasma pH of <7.38) were identified. Control patients were randomly selected from among a large cohort of patients who initiated a dual NRTI regimen in 1996 or after. Two factors were associated with an increased risk of lactic acidosis: first, a creatinine clearance of <70 mL/min before lactic acidosis (OR, 15.8 [range, 3.0-86.5], P<10(-4)), and, second, a low nadir CD4+ T lymphocyte count before the inception of NRTI therapy (OR, 8.4 [range, 1.2-infinity], P=.03). The total cumulative exposure to NRTIs was not associated with an increased risk of lactic acidosis, nor was the cumulative exposure to any of the 4 NRTIs studied. According to these results, monitoring of creatinine clearance, especially in patients with a low nadir CD4+ T lymphocyte count, could lead to modifications in antiretroviral therapy in order to diminish the risk of occurrence of lactic acidosis.

血糖コントロール不良インスリン使用糖尿病患者におけるメトホルミン併用効果

A new way of administrating metformin has been reviewed for the treatment of diabetic patients suffering from obesity and insulin resistance.We studied the effectiveness of the combined administration of metformin and insulin in diabetic patients who were severely or slightly obese. These patients were selected from a group of inpatients and outpatients at Tokyo Metropolitan Futyu Hospital during the period from April 1999 to January 2001. We included 37 patients who were obese and who possibly demonstrated insulin resistance, and who also had problems controlling their blood glucose level despite insulin treatment. Patients were excluded if they were diagnosed to have either a hepatic or renal dysfunction or either cardiovascular or any circulatory disorders since they are risk factors for lactic acidosis after the administration of metformin.After evaluation of the results of the combined administration of metformin and insulin, and also controlling the blood glucose level, and by varying the dosages of insulin, an improvement in the control of the blood glucose level was observed in 30 patients, and a reduction in the dosage of insulin was observed in 11 patients. No side effects which required a discontinuation of medications were discovered during the study period.The previously reported administration ranged from 850-2, 500mg/day in the U.S. and Europe. In addition to the combination use of 500mg-750mg/day of metformin with insulin was also found to be effective. Based on these results, we believe that further clinical studies with a larger number of patients are called for to evaluate the optimal administration dosage of metformin.