Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Metformin Use and Hospitalization with Acidosis

JAMA Intern Med; 2018 Jul; Lazarus, et al

Metformin use may be safe in patients with type 2 diabetes (T2D) at estimated glomerular filtration rate (eGFR) 30 to 60 mL/min/1.73 m2 and was associated with acidosis only at eGFR <30 mL/min/1.73 m2, a recent study found. In 2 large retrospective cohorts of patients with diabetes mellitus (Geisinger Health System, n=75,413 and MarketScan, n=82,017), researchers sought to quantify the association between metformin use and hospitalization with acidosis across the range of eGFR, accounting for change in eGFR stage over time. They found:

  • There were 2,335 hospitalizations with acidosis over a median follow-up of 5.7 years.
  • Compared with alternative diabetes management, time-dependent metformin use was not significantly associated with incident acidosis overall (adjusted HR, 0.98) or in patients with eGFR 45 to 59 mL/min/1.73 m2 (adjusted HR, 1.16) and eGFR 30 to 44 mL/min/1.73 m2 (adjusted HR, 1.09).
  • Conversely, metformin use was associated with an increased risk of acidosis at eGFR <30 mL/min/1.73 m2 (adjusted HR, 2.07).


Lazarus B, Wu A, Shin J, et al. Association of metformin use with risk of lactic acidosis across the range of kidney function. A community-based cohort study. JAMA Intern Med. 2018;178(7):903–910. doi:10.1001/jamainternmed.2018.0292.

This Week's Must Reads

Patient-Centered Intervention for Prostate Ca Care, J Clin Oncol; ePub 2019 Mar 12; Jayadevappa, et al

Subsequent Cancer Risk in Prostate Cancer, Lancet Oncol; ePub 2019 Mar 15; Mohamad, et al

Accuracy of 68Ga-PSMA-11 PET in Prostate Cancer, JAMA Oncol; ePub 2019 Mar 28; Fendler, et al

Low Muscle Mass in Patients with Prostate Cancer, J Urol; ePub 2019 Mar 27; Pak, Park, et al

Steroid Hormones & Progression of Prostate Cancer, Cancer Epidemiol Biomarkers Prev; ePub 2019 Mar 27; Lévesque, et al

Must Reads in Diabetes

Testosterone Therapy to Prevent T2D in Men, Diabetes Care; ePub 2019 Mar 18; Yassin, et al

Patterns of Diabetes Screening During Office Visits, J Am Board Fam Med; 2019 Mar-Apr; Shealy, et al

Muscular Strength and Incidence of Type 2 Diabetes, Mayo Clin Proc; ePub 2019 Mar 11; Wang, et al

Insulin Management in Patients with T2D, Lancet; ePub 2019 Feb 22; Bergenstal, et al

Hospitalization Rates in Young-Onset Diabetes, Ann Intern Med; ePub 2019 Jan 15; Ke, Lau, et al