Most important, these figures do not include patients who are receiving no oral diabetes agents, so they are almost certainly underestimates. If these rates were extended down to an eGFR of 30 mL/min, the number of patients taking metformin would increase by about an additional 560 000. If the 90.4% use rates listed above for an eGFR exceeding 90 mL/min were seen with an eGFR greater than 60 to 90 mL/min, approximately 425 000 additional patients would take metformin. At eGFRs below 30 mL/min, at which metformin use is discouraged, the rate was 17.9%.Īn estimate of the influence of renal contraindications on metformin use is summarized in the Table. At eGFRs of 30 to 60 mL/min, at which metformin use is usually formally contraindicated but professional guidelines 1 support cautious use, rates were 48.6% to 57.4%. At eGFRs greater than 60 to 90 mL/min, at which renal function is mildly impaired but the serum creatinine level is typically below the contraindication cutoff, the rate was 80.6%. In 2011-2012, the rate of metformin use in patients with an eGFR exceeding 90 mL/min was 90.4% ( Figure). 1 Because this contraindication may inappropriately discourage metformin use in patients with mild renal impairment, US Food and Drug Administration (FDA) citizen petitions 4, 5 were filed in 20, respectively, requesting that the contraindication be relaxed and reframed in terms of the more modern eGFR measure, although the FDA has provided no substantive response. 1, 3 Professional societies support metformin use at estimated glomerular filtration rates (eGFRs), a better measure of renal function than the serum creatinine level, of 45 or even 30 mL/min (which typically equates to a serum creatinine level of about 2 mg/dL). This contraindication has been widely criticized as overly conservative. The drug carries a contraindication against use when serum creatinine levels exceed 1.4 mg/dL in women or 1.5 mg/dL in men based on fears about lactic acidosis (to convert creatinine level to micromoles per liter, multiply by 88.4). One likely explanation for this shortfall is the avoidance of metformin use in renal insufficiency. Even in patients who are taking other oral T2DM drugs, only about 70% use metformin. Despite this, half of the patients with T2DM do not take metformin. Metformin hydrochloride is the first-line drug for type 2 diabetes mellitus (T2DM) 1 and is the only oral diabetes drug with evidence for improved cardiovascular outcomes. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.
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