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Inappropriate Metformin Use Frequent in Hospitalized Patients: Presented at ADA
By Jill Stein
NEW ORLEANS, LA -- June 16, 2003 -- Hospitals appear to use metformin inappropriately among more than one-third of in-patients, researchers reported here on June 14th at the 63rd Scientific Sessions of the American Diabetes Association.
Dr. Peter Dumo, of the Detroit Medical Center in Detroit, Michigan, United States, and coworkers reviewed records in 314 hospitalized patients who were prescribed metformin, an oral antihyperglycemic drug used in the management of noninsulin-dependent diabetes mellitus. They collected data on comorbid conditions, concurrent medications, admitting service, discharge instructions, and demographic characteristics.
"Metformin is a very commonly prescribed antihyperglycemic agent in North America," Dr. Dumo pointed out. "It is effective and well tolerated. However, concern about lactic acidosis has limited its use in certain high-risk patients."
Their study was undertaken to assess whether the current contraindications to metformin were being followed in 314 hospitalized patients.
Eighty-three percent of patients prescribed metformin had received the drug on previous occasions, and the mean dose prior to admission was 1,159 mg/day.
Thirty-eight percent of patients prescribed metformin had an active contraindication to its use. Heart failure and renal insufficiency accounted for 74% of all metformin contraindications.
The drug was withheld temporarily or withdrawn in 49% of patients with contraindications to its use. However, 31% of these interruptions were due to NPO (nothing by mouth) status, which is not recognition of drug contraindication.
Thirty two percent of patients discharged on metformin had an ongoing contraindication to its use, with heart failure the leading contraindication.
"The findings, which are consistent with other published data, suggest that hospitals need to carefully review their use of metformin," Dr. Dumo said.
A potential limitation of the study is its retrospective design, he added.
He noted that his team is carrying out multiple interventions involving pharmacists, physicians, and computer support to improve metformin safety.
[Study title: Inappropriate Metformin Use in Hospitalized Patients. Abstract 503]
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