Table 1 1 summarises some of these differences. Metformin and phenformin have different pharmacological characteristics that could explain the much lower incidence of lactic acidosis associated with metformin. However, despite increased disregard of contraindications to metformin, as discussed below, the incidence of lactic acidosis has not increased.
3 6 w3 w6 w10-w12 This difference in the incidence of lactic acidosis between metformin and phenformin could be due to more stringent contraindications applied after the experience with phenformin. Phenformin related lactic acidosis had an estimated incidence of 0.25-1 case per 1000 patient years compared with an estimated incidence of 0-0.09 case per 1000 patient years with metformin. 6 w7 w8 Metformin is less likely than phenformin to cause lactic acidosis. 4 5 w4 w7-w9 Most of the evidence for the association between metformin and lactic acidosis is historical data for phenformin (withdrawn in 1977). An increasing body of evidence challenges the so called “contraindications” to metformin. The perceived risk of developing lactic acidosis with metformin is high, particularly in the United States. Metformin and risk of lactic acidosis: what evidence? In this article we review the evidence for the use of metformin in the presence of stated contraindications and especially for patients with heart failure. 3 w6 w7 The box summarises the current contraindications to metformin use. 2 w4 w5 Perhaps as a result of this, many suitable patients with type 2 diabetes are denied metformin treatment. 1ĭespite the evidence base for the benefits of metformin, concerns remain about its side effects and especially the perceived risk of lactic acidosis in the presence of renal, hepatic, respiratory, or cardiac failure. 1 It was also associated with reduced all cause mortality, which was not seen in patients with equally well controlled blood glucose treated with sulphonylureas or insulin. w2 w3 The UK prospective diabetes study showed that metformin was associated with a lower mortality from cardiovascular disease than sulphonylureas or insulin in obese patients with type 2 diabetes mellitus. w1 The mechanism of action has been extensively reviewed. Metformin first became available in the United Kingdom in 1957 but was first prescribed in the United States only in 1995. Pētera slimnīcaįakultāte: St.Further studies are needed to assess the risk of lactic acidosis in patients with type 2 diabetes and traditional contraindications to metformin Slimnīcu Saistīts: Albany Medical Center, St. Galda Sertifikācija: Sirds un asinsvadu slimība ehokardiogrāfija Kodolenerģija kardioloģija Specialitātes: Sirds un asinsvadu slimība, ehokardiogrāfija, Nuclear Medicine Kad viņš nav praktizē kardioloģija, he enjoys spending time with his family, playing tennis, and watching Siena basketball. He lives in Guilderland with his wife and three children.
He has a special interest in koronāro artēriju slimība treatment and prevention, sastrēguma sirds mazspēja, un noninvasive cardiac imaging. Uzzilia has a broad interest in general sirds un asinsvadu slimība. Pētera slimnīca un Albany medicīnas centrs.ĭr. Uzzilia is the director of the echocardiography laboratory at Capital Cardiology and the Chief of Noninvasive Cardiology at St. Viņš ir biedrs American College Kardioloģijas, and Fellow of the American Society of Echocardiography. Uzzilia is board certified in internal medicine, sirds un asinsvadu slimība, nuclear cardiology and ehokardiogrāfija. Following his residency, he completed a fellowship in cardiovascular disease at Albany Medical Center in 2005.ĭr. He then completed an internship and residency in internal medicine at Albany Medical Center. Uzzilia graduated from Siena College in 1998 and from Albany Medical College in 2002.
0 kommentar(er)
