Who can take metformin?

There are fewer contraindications to the appointment of metformin

Anna Stavina, XX2 century

Metformin intake is associated with a decrease in mortality from all causes in patients suffering from type 2 diabetes mellitus, chronic kidney disease, congestive heart failure and chronic liver diseases with liver failure. This conclusion was reached by the authors of a systematic review prepared on the basis of 17 observational studies. The use of metformin was also associated with a decrease in the number of repeated hospitalizations of patients with the above-mentioned heart and kidney diseases.

The results of the work prepared under the guidance of Dr. Matthew Crowley from Duke University and the Durham Veterans Affairs Medical Center in Durham (North Carolina, USA) were published in the Annals of Internal Medicine (Clinical Outcomes of Metformin Use in Populations With Chronic Kidney Disease, Congestive Heart Failure, or Chronic Liver Disease: A Systematic Review).

When the U.S. Food and Drug Administration (FDA) approved the use of metformin in 1994, the drug quickly became a starting therapy for many patients suffering from type 2 diabetes. However, the same administration required that a warning be published on metformin packages prohibiting the use of this drug in chronic kidney disease. The use of metformin in patients with congestive heart failure and liver disease was allowed, but only "with caution".

The authors of the new review noted that in 2006 congestive heart failure was removed from the list of contraindications to the appointment of metformin, but the warning regarding the use of the drug in acute or unstable congestive heart failure remained. In April 2016 The FDA has also changed its position regarding the use of metformin in chronic kidney disease. Now the main criterion determining the possibility of prescribing this drug has become the glomerular filtration rate. As a result, patients with moderate kidney disease were able to receive metformin – only severe forms of the disease remained on the list of contraindications.

Interest in the use of metformin in patients with various comorbidities is constantly growing. So, recently, a study was conducted on the effectiveness of low doses of this drug for weight loss in schizophrenia patients receiving clozapine. The work included patients with previously diagnosed metabolic disorders.
It turned out that a 12-week course of metformin at a dosage of 1000 mg / day leads to a decrease in body weight by an average of 0.97 kg. In the group receiving 500 mg of the same drug, no such effect was noted. However, body mass index (BMI) decreased in both groups. After 12 weeks of taking 1000 or 500 mg of metformin per day, BMI decreased by 0.7 or 0.5 kg / m2, respectively.

During the preparation of the work, the researchers studied a number of publications published in the period from 1994 to 2016. For the review, 17 observational studies were selected, in which patients with type 2 diabetes, moderate or severe kidney disease, congestive heart failure or chronic liver disease with liver failure participated. After analyzing these studies, the scientists found that taking metformin was associated with a decrease in mortality from all causes in all three groups of patients. In volunteers with kidney and heart diseases, there was also a decrease in the frequency of hospitalizations, and in patients with moderate chronic kidney disease, the frequency of hypoglycemia episodes also decreased.

"Although the amount of data was limited, we found no evidence that patients [with moderate kidney disease, congestive heart failure, or chronic liver disease with hepatic insufficiency] could not benefit from taking metformin," the researchers concluded. "Combined with information about the safety of metformin in terms of lactic acidosis, our observations support recent actions taken by the FDA."

Recently, several observational studies have also mentioned that taking metformin is associated with a reduced risk of breast cancer (breast cancer) in patients with type 2 diabetes mellitus. However, a large-scale study, during which the authors analyzed the medical histories of approximately 50 thousand women over 65 who took either metformin or sulfonylurea-based drugs (for example, glipizide or glibenclamide), did not confirm this hypothesis. There was no statistically significant difference in the incidence of breast cancer in these groups.

Scientists noted the limitations of the work carried out. In particular, they mentioned that the study did not analyze all possible outcomes for patients. In addition, the review was based on the results of observational studies, in which the severity of the previous disease was not always noted. Separately, the review authors mentioned the lack of randomized studies on the effectiveness of metformin in patients with chronic kidney disease, congestive heart failure and liver failure. Additional studies are needed in which the use of metformin by patients with historically determined contraindications and limitations would be compared with the use of other medications.

"The available data do not indicate that the risks associated with the use of metformin exceed similar risks of other hypoglycemic drugs," the scientists stressed.

Portal "Eternal youth" http://vechnayamolodost.ru  07.03.2017