An oral diabetes drug, by the name of metformin, is suggested to be safe for most diabetic individuals with chronic kidney disease (CKD) according to a recent research study.
For the treatment of type 2 diabetes, Metformin is prescribed as the first-line medication. However, the use of Metformin has raised concerns in the medical community because it is believed that it may lead to lactic acidosis, explains a senior study author Morgan Grams, M.D.,Ph.D., M.H.S., an associate professor of medicine and epidemiology at the Johns Hopkins University School of Medicine.
A rare but serious complication, lactic acidosis is caused by lactate accumulation in the bloodstream that leads to severe muscle pain, cramps, and weakness. This means that diabetic individuals with CKD hold an increased risk of metformin-associated lactic acidosis. An effective examination of lactic acidosis risk could "provide reassurance that millions of people with diabetes and CKD may be able to safely use metformin," explains Grams. Older studies show that metformin holds great benefits beyond the purview blood sugar control. These benefits include less weight gain, lower risk of a heart attack, and higher long-term survival than other blood-sugar controlling prescriptions. "Our study demonstrates that the first-line and common diabetes medication is safer in patients with CKD than once thought," Grams says. "From a public health perspective, the potential benefits of using metformin for patients with diabetes and CKD are vast, given the increasing number of people affected with both diseases worldwide."
For the research study, Grams and co-authors examined 2004-2017 medical record data taken from 75,413 patients with type 2 diabetes managed by Geisinger Health System in Pennsylvania. Investigators analyzed data from the patients' estimated glomerular filtration rates (eGFRs -- a measure of kidney function), prescription drugs used for diabetes management, acidosis hospitalization visits, demographics, smoking habits/status and any indication of cardiovascular disease. The researchers used computer-based statistical models to study the risk of acidosis development in metformin users in comparison to metformin nonusers. Some conditions were adjusted for cardiovascular disease and smoking status. Overall, the research team found a relationship between metformin use and acidosis which was evident in patients with severely decreased kidney function. The researchers found a strikingly high risk in patients with severely decreased kidney function who were on a different type of diabetic medication. Additionally, the investigators compared new metformin users with new users of other diabetic managing drugs known as sulfonylureas within different categories of CKD stages.
"Our results support cautious use of metformin in patients with type 2 diabetes and eGFR of at least 30 mL/min/1.73 m2," Grams says. While investigators believe that this data is promising, they warn that patients receiving metformin may have varying underlying risk of lactic acidosis than patients who have not received metformin.
Source: Johns Hopkins Medicine
