Diabetes, Metformin and Lactic Acidosis

Glad to read this ,as I am on Metformin..Thanks for the article :0)

Yes, this is consistent with the reading I've done. It is rare (one in 30,000) and typically if certain functions are compromised, which with diabetics they often are. Not a direct correlation for sure, but a side effect worth looking into depending on your current health.

J Kate…I find this to be a very comforting and validating piece of evidence. Especially since I have been on Met for a few years. Thanks!

That stands to reason and this certainly takes the heat off Metformin. I was only warned of the potential of LA along with drinking alcohol on this med.

Very wordy… but it is basically saying that diabetes was found to be the cause rather than metformin. Hmmm. imagine that, diabetes the cause of kidney problems.

Apparently the link is not working… Here is the report:
Objective Metformin has long been thought to cause lactic acidosis (LA) but evidence from various sources has led researchers to question a direct causative relationship. We assessed the relationship of metformin prescription and other factors to the incidence of LA.
Methods All cases of LA at a single hospital were identified from laboratory lactate measurements. We compared patients classified as Cohen and Woods class A and B, patients with and without diabetes, and those taking metformin or not.
Results LA was more common than in published analyses based on hospital coding of diagnoses. The incidence of LA was greater in diabetes than in the nondiabetic population but with no further increase in patients taking metformin. Lactate levels were no greater in patients on metformin than in patients with type 2 diabetes not on metformin even if patients with acute cardiorespiratory disturbance (Cohen and Woods class A) were excluded. Acidosis was greater in diabetes (hydrogen ion 94·9 ± 4·6 vs 83·2 ± 2·3 10−9 M, P = 0·027) but factors besides lactate contributed. Acute cardiorespiratory illness, acute renal impairment and sepsis were the most common of the recognized precipitating factors. Age (P = 0·01), acute renal failure (P = 0·015) and sepsis (P = 0·005) were associated with mortality.
Conclusions Diabetes rather than metformin therapy is the major risk factor for the development of LA. Lactic acidosis occurs in association with acute illness particularly in diabetes. Current guidance for the prevention of lactic acidosis may overemphasize the role of metformin.

Introduction
Metformin has been used in Europe for the treatment of type 2 diabetes since the 1970s. Its usage increased following publication of the results of the UKPDS study.[1] However, concerns about the risk of lactic acidosis (LA) delayed the introduction of metformin into clinical practice in the USA until 1995 and have persisted.[2] Its predecessor biguanide, phenformin, clearly caused lactic acidosis, and it has been suggested that metformin has been judged guilty by association.[3] Estimates have suggested the incidence of LA is 10–20 times less with metformin compared to phenformin.[4]

It has been suggested that the development of LA in patients on metformin is primarily linked to the presence of known risk factors, particularly ischaemic heart disease (IHD), renal impairment and liver disease.[5] However, issues of prevalence and causative factors remain unresolved by previous studies. Several large surveys identified no cases of LA in metformin users.[6–8] Yet LA in patients taking metformin continues to be seen in practice. It remains unclear as to whether this is a causative link or association for some other reason.[7] The advice to avoid metformin prescription in patients with any of a large number of risk factors recorded in the literature is therefore offered without a strong evidence base.

This analysis was carried out to provide further information on the prevalence of LA in general hospital practice and any implications for the prevention of what is a life-threatening disorder.