Metformin use in patients with type 2 diabetes mellitus and chronic kidney disease: An evidence-based review.
10.47102/annals-acadmedsg.2020464
- Author:
Felicia Clara J H TAN
1
;
Seng Bin ANG
;
Yong Mong BEE
Author Information
1. Family Medicine Service, KK Women's and Children's Hospital, Singapore.
- Publication Type:Journal Article
- From:Annals of the Academy of Medicine, Singapore
2021;50(2):159-170
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Practice guidelines advise caution on the use of metformin in patients with type 2 diabetes mellitus with chronic kidney disease (CKD). This review aims to examine the evidence for the benefits and risks of metformin use in patients with T2DM and CKD.
METHODS:The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and PubMed were searched; the references of selected papers were hand searched. Systematic reviews, randomised controlled trials, cohort studies, case series and case-control studies were included. The full text of selected articles was reviewed. The outcomes studied were all-cause mortality, cardiovascular complications, lactic acidosis and worsening of renal function. Recommendations were graded according to the Scottish Intercollegiate Guidelines Network system.
RESULTS:A total of 139 unique articles were identified, 14 of which met the inclusion criteria and were selected for full-text review. Four cohort studies reported an association between metformin use and improved all-cause mortality in CKD stage 4 and better. Two cohort studies reported improved cardiovascular outcomes with metformin use. Four cohort studies, 1 case series and 1 case-control study reported no significant association between metformin use and an increased risk of lactic acidosis in CKD. There is a moderate level of evidence to support reduced mortality, improved cardiovascular outcomes and a low risk of lactic acidosis with metformin use in patients with T2DM and with CKD stage 4 and above.
CONCLUSION:Existing recommendations to restrict metformin use in diabetes patients with CKD need to be reviewed in light of emerging evidence supporting its overall benefits in these patients.
