Safe Use of Metformin in Adults with Type 2 Diabetes and Chronic Kidney Disease – Lower Doses and Sick Day Education Are Essential

Publication date: Available online 25 April 2018Source: Canadian Journal of DiabetesAuthor(s): Lori MacCallum, Peter A. SeniorAbstractMetformin, together with lifestyle intervention, is considered first line for glycemic management in type 2 diabetes. Despite this widespread use, one of the areas of longstanding debate has been whether metformin can be safely used in those with chronic kidney disease (CKD). The concern is the possibility of an increased risk of lactic acidosis resulting from metformin accumulation in those with renal impairment. As options in this patient population are limited and many believe this risk has been overstated, several organizations around the world have made recommendations to allow for the cautious use of metformin in patients with CKD. Lalau and colleagues have added new evidence with the publication of three complementary studies on the use of metformin in people with CKD stages 3A, 3B or 4; a dose finding study, a chronic metformin treatment study and a pharmacokinetic study. The authors tested adjusted dosage regimens based on level of CKD. The study demonstrates that although there is a relationship between eGFR and metformin levels, there is not a relationship between metformin levels and plasma lactate. In addition, as long as the metformin dose was adjusted to level of CKD, pharmacokinetics remained stable. Based on this new evidence together with past epidemiological data and systematic reviews, metformin appears to be a safe option f...
Source: Canadian Journal of Diabetes - Category: Endocrinology Source Type: research

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AbstractObesity is a common and complex health problem worldwide and can induce the development of Type 2 diabetes. Chronic kidney disease (CKD) is a complication occurring as a result of obesity and diabetic conditions that lead to an increased mortality rate. There are several mechanisms and pathways contributing to kidney injury in obese and diabetic conditions. The expansion of adipocytes triggers proinflammatory cytokines release into blood circulation and bind with the receptors at the cell membranes of renal tissues leading to kidney injury. Obesity ‐mediated inflammation, oxidative stress, apoptosis, and mitochon...
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Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association’s four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 20 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a ...
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Source: JAMA - Category: General Medicine Source Type: research
Conditions:   Chronic Kidney Disease Due to Hypertension;   Chronic Kidney Disease Due to Type 2 Diabetes Mellitus Interventions:   Biological: Faecal microbiota transplant;   Biological: Placebo Sponsor:   Hospital Universitario Dr. Jose E. Gonzalez Completed
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
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