Article (Scientific journals)
Metformin revisited: A critical review of the benefit-risk balance in at-risk patients with type 2 diabetes.
SCHEEN, André; Paquot, Nicolas
2013In Diabetes and Metabolism, 39 (3), p. 179-190
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Keywords :
Coronary artery disease; Type 2 diabetes; Renal insufficiency; Elderly; Heart failure; Lactic acidosis; Metformin
Abstract :
[en] Metformin is unanimously considered a first-line glucose-lowering agent. Theoretically, however, it cannot be prescribed in a large proportion of patients with type 2 diabetes because of numerous contraindications that could lead to an increased risk of lactic acidosis. Various observational data from real-life have shown that many diabetic patients considered to be at risk still receive metformin and often without appropriate dose adjustment, yet apparently with no harm done and particularly no increased risk of lactic acidosis. More interestingly, recent data have suggested that type 2 diabetes patients considered at risk because of the presence of traditional contraindications may still derive benefit from metformin therapy with reductions in morbidity and mortality compared with other glucose-lowering agents, especially sulphonylureas. The present review analyzes the benefit-risk balance of metformin therapy in special populations, namely, patients with stable coronary artery disease, acute coronary syndrome or myocardial infarction, congestive heart failure, renal impairment or chronic kidney disease, hepatic dysfunction and chronic respiratory insufficiency, all conditions that could in theory increase the risk of lactic acidosis. Special attention is also paid to elderly patients with type 2 diabetes, a population that is growing rapidly, as older patients can accumulate several comorbidities classically considered contraindications to the use of metformin. A review of the recent scientific literature suggests that reassessment of the contraindications of metformin is now urgently needed to prevent physicians from prescribing the most popular glucose-lowering therapy in everyday clinical practice outside of the official recommendations.
Disciplines :
Pharmacy, pharmacology & toxicology
Endocrinology, metabolism & nutrition
Author, co-author :
SCHEEN, André  ;  Centre Hospitalier Universitaire de Liège - CHU > Diabétologie,nutrition, maladies métaboliques
Paquot, Nicolas ;  Université de Liège - ULiège > Département des sciences de la santé publique > Nutrition
Language :
English
Title :
Metformin revisited: A critical review of the benefit-risk balance in at-risk patients with type 2 diabetes.
Publication date :
May 2013
Journal title :
Diabetes and Metabolism
ISSN :
1262-3636
eISSN :
1878-1780
Publisher :
Masson, Moulineaux Cedex 9, France
Volume :
39
Issue :
3
Pages :
179-190
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
Copyright (c) 2013. Published by Elsevier Masson SAS.
Available on ORBi :
since 02 April 2013

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