A recent study reported a significant
increase in all-cause mortality associated with the use of metformin
in patients with type 2 diabetes. Yes, I can believe this as I have
been taken off metformin recently because my kidney disease was
moving closer to stage 3 and my doctor said to stop immediately. It
will be interesting to see if there is improvement at my next
appointment in late October.
Metformin is currently recommended as
first line treatment for type 2 diabetes. However, its use is often
limited in patients with chronic kidney disease stage 3 or higher due
to the risk of lactic acidosis. I have not had any symptoms of
lactic acidosis and feel fortunate for that. Since I will only use
metformin and insulin, I was disappointed in having metformin removed
as it had been helping me maintain and lose some weight.
The study took place in Taiwan, which
allows metformin to be used in all stages of chronic kidney disease.
Other countries in the world vary to greater extent and this allowed
for this study to be more accurate. The finding of this study
confirmed that metformin is associated with higher death rate among
type 2 diabetes patient with higher stage of chronic kidney diseases.
My doctor did ask if I would consider
using another oral medication or an injectable medication along with
my insulin. I was very firm that I would not and going forward, I
would rely on insulin only. She said that would be best and agreed
with me. What I did not say is that I would not until it was proven
that some of the side effects have been proven not to be harmful.
For metformin, the increased mortality
risk was associated with higher dose and remained consistent across
all subgroups. Finally, metformin users did not differ significantly
from non-metformin users group in regard to risk of metabolic
acidosis.
This study did confirm that metformin
is associated with a higher death rate among type 2 diabetes patient
with higher stage of chronic kidney diseases.
The study findings have therapeutic
implications, supporting the current recommendations that metformin
should not be used in patients with stage 5 chronic kidney disease.
In addition, the researchers also
recommended future study evaluating the use of metformin in patients
with less severe chronic kidney disease.
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