Pongwecharak Juraporn, Tengmeesri Nawatsanan, Malanusorn Nongluck, Panthong Matshamon, Pawangkapin Nantida
Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hatyai, Songkhla, 90112, Thailand.
Pharm World Sci. 2009 Aug;31(4):481-486. doi: 10.1007/s11096-009-9303-2. Epub 2009 May 22.
(1) To determine the prevalence of metformin prescribing in type 2 diabetes with a contraindication and (2) to explore whether metformin use on top of contraindications modified the risks of lactic acidosis, hospitalization, and death in type 2 diabetes.
Ambulatory diabetic clinics of the secondary-level care General Hospital of Hatyai district, Songkhla province, South Thailand.
A cross-sectional study was carried out for the objective (1). A retrospective cohort study was applied to meet the objective (2). Out-patient medical case notes were reviewed for metformin use, number of hospitalizations, lactic acidosis cases, death cases, and the presence of contraindications, which were limited to: (1) chronic renal impairments, (2) chronic liver diseases, and (3) cardiac failure. Only documented diagnoses of the above conditions were counted.
The prevalence of metformin use in type 2 diabetes with a contraindication; odds ratios (ORs) of the occurrences of lactic acidosis, hospitalization, and death in type 2 diabetes with a contraindication modified by metformin use.
A total of 1,630 type 2 diabetic outpatients were identified; 19.3% (315/1,630) had at least one contraindication to metformin use, with chronic renal impairment being the most frequent risk (78%, 246/315). Of those with a contraindication, 84.4% (266/315) were metformin users. Compared to non-metformin users, there were no significant differences in the number of hospitalizations and deaths. No cases of lactic acidosis were evident. Metformin use in the presence of contraindications did not affect the risks of hospitalization (OR 0.73, 95% confidence interval [CI] 0.38-1.4, P = 0.34) or death (OR 0.58, 95% CI 0.11-3.15, P = 0.53). Other patient factors, such as the female gender or having diabetes-related complications, had significant influences on both outcomes.
The prevalence of type 2 diabetes receiving metformin despite having a contraindication was over 80%. However, metformin use in such conditions did not appear to increase the risks of hospitalization and death. No lactic acidosis was reported. Other patient factors than metformin affect the risks of hospitalization and death.
（1）确定在存在禁忌证的2型糖尿病患者中二甲双胍的处方率；（2）探讨在存在禁忌证的情况下使用二甲双胍是否会改变2型糖尿病患者发生乳酸性酸中毒、住院及死亡的风险。
泰国南部宋卡府合艾区二级护理综合医院的门诊糖尿病诊所。
针对目标（1）开展了一项横断面研究。采用回顾性队列研究以实现目标（2）。查阅门诊病历以了解二甲双胍的使用情况、住院次数、乳酸性酸中毒病例、死亡病例以及禁忌证的存在情况，禁忌证仅限于：（1）慢性肾功能损害；（2）慢性肝病；（3）心力衰竭。仅计算上述疾病的确诊记录。
存在禁忌证的2型糖尿病患者中二甲双胍的使用比例；在存在禁忌证的情况下使用二甲双胍对2型糖尿病患者发生乳酸性酸中毒、住院及死亡的比值比（OR）。
共确定1630例2型糖尿病门诊患者；19.3%（315/1630）至少存在一项二甲双胍使用禁忌证，其中慢性肾功能损害是最常见的风险因素（78%，246/315）。在存在禁忌证的患者中，84.4%（266/315）使用二甲双胍。与未使用二甲双胍的患者相比，住院次数和死亡人数无显著差异。未发现乳酸性酸中毒病例。在存在禁忌证的情况下使用二甲双胍并不影响住院风险（OR 0.73，95%置信区间[CI] 0.38 - 1.4，P = 0.34）或死亡风险（OR 0.58，95% CI 0.11 - 3.15，P = 0.53）。其他患者因素，如女性或患有糖尿病相关并发症，对这两种结局均有显著影响。
尽管存在禁忌证，但仍接受二甲双胍治疗的2型糖尿病患者比例超过80%。然而，在此种情况下使用二甲双胍似乎并未增加住院和死亡风险。未报告乳酸性酸中毒病例。除二甲双胍外，其他患者因素影响住院和死亡风险。
