Patient Care

Evaluating Management and Change in Glycemic Control After Discontinuation of Metformin in Patients With Elevated Serum Creatinine

Recently revised FDA labeling allows many patients with mild-to-moderate kidney disease to benefit from treatment with metformin.

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According to the American Diabetes Association (ADA), about 29 million Americans have diabetes mellitus (DM). Uncontrolled DM causes various microvascular and macrovascular complications and leads to significant mortality. In 2011, DM was the seventh leading cause of death. 1 The ADA recommends setting a hemoglobin A 1c (HbA 1c) goal of < 7% to prevent microvascular and macrovascular complications. 1

The treatment cost of DM continues to rise and accounts for about $245 billion annually. 1 Given its effectiveness, low cost, and low adverse-event (AE) profile, metformin has been the cornerstone of therapy in DM over the past 20 years. The ADA recommends metformin as first-line therapy in type 2 DM (T2DM). In 2014, 14.4 million Americans were dispensed a metformin-containing product. 2 Metformin exerts its effect mainly by decreasing hepatic glucose production and increasing insulin sensitivity. Study results suggest gluconeogenesis may be decreased up to 75% in these patients. 3 Metformin is effective in reducing the level of HbA 1c by an average of 1.5%. 3

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