Dr. Adil Ramzan

When Metformin, if given, increases mortality? Dr. Adil Ramzan

Studies have shown Metformin has a number of benefits, some say it is a miraculous drug. Metformin has shown following properties;

  1. Its antiging
  2. It reduces the risk of cancer
  3. Decreases the risk of stroke, cardiovascular diseases,
  4. Decreases progression of atherosclerosis
  5. Reduces the risk of developing open angle glaucoma
  6. Helps to induce ovulation in polycystic cystic ovarian syndrome.

The potential benefits of giving metformin outweigh the potential risk, so Metformin has become the first line drug therapy against type 2 diabetes mellitus.

Dr. Rauf Niazi, Professor of Medicine and Endocrinology called metformin “a life extension drug” and recommended that people may start using metformin in low doses by the age of 30.

But there are certain condition when metformin, if given may increase mortality.

When a type 2 diabetic is first started on a sulfonylurea and continued on sulfonylurea for several years and never had been given metformin, if such patient is started with metformin, then starting metformin actually increases mortality in such patients.

So if a patient had been started on sulfonylurea initially and he has been taking sulfonylurea for several years then if such a patient comes to you, don’t start him on metformin. Studies have suggested that if metformin is given to such patients, it actually increases mortality.

In patients of CKD stage 3 or higher the use of metformin is limited due to the increased risk of lactic acidosis. A study suggested that mortality rate in a group of patients who were taking metformin and had CKD stage 3 or higher was 53% as compared to those who were not taking metformin (41%).

So metformin use in the patients of CKD stage 3 or higher is not recommended and metformin increases the all-cause mortality in such patients (53% vs 41%). Metformin was found to be an independent risk factor for mortality.

References:

Metformin May Increase Mortality in Advanced CKD among Type 2 Patients. July 10, 2015. Url: https://www.diabetesincontrol.com/metformin-may-increase-mortality-in-advanced-ckd-among-type-2-patients/

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