The Outcome of Implementing the Clinical Practice Guideline for Metformin Associated Lactic Acidosis (MALA) Prevention in Chaiyaphum Hospital

Abstract

Introduction: The incidence of Metformin Associated Lactic Acidosis (MALA) was 4.60 cases per 100,000 patient-years. This adverse drug reaction of metformin is rare but results in severe and life-threatening complications. In the fiscal year 2020, the clinical practice guideline (CPG) for MALA prevention was using at Chaiyaphum Hospital.

Objective: This research aimed to investigate the effect of implementing CPG for prevent incidence of MALA among type 2 diabetes patients at Chaiyaphum Hospital.

Methods: This research was a retrospective descriptive study was conducted from medical records of 19,172 type 2 diabetes patients admitted to Chaiyaphum Hospital in the fiscal year 2019-2022 according to inclusion and exclusion criteria. The baseline data were collected such as gender, renal function values, treatment, MALA incidence. Data were analyzed using descriptive statistics as number, percentage, and MALA incidence rate

Results: Most of the patients with type 2 diabetes who received treatment in fiscal year 2019-2022 were female 64.94, 63.33, 63.15 and 62.57% chronic kidney disease stage 3a 91.52, 93.12, 94.46 and 95.36% and the most common daily dose of metformin in patients was 500-1,000 mg/day 56.03, 57.47, 55.63 and 59.71%. Before implemented this CPG in the fiscal year 2019, the incidence of MALA was 225.59 cases per 100,000 patients-years. After implemented this CPG in the fiscal year 2020-2022, the incidence of MALA was 209.91, 156.25 and 108.44 cases per 100,000 patients-years, respectively.

Conclusion and Discussion: Based on the results of this study, the CPG for MALA prevention was decreased incidence of MALA in type 2 diabetes patients.