The Incidence and Associated Factors of Metformin-associated lactic acidosis ( MALA ) in patients with type 2 Diabetes Mellitus
Abstract
Background: Metformin is the first-line treatment for type 2 diabetes. Although generally safe, it carries a risk of metformin-associated lactic acidosis (MALA), a rare but serious condition. Understanding the incidence and risk factors of MALA in patients using Metformin are vital to establish appropriate medication guidelines and to prevent MALA
Objective: To examine the incidence and factors associated with MALA in patients with type 2 diabetes
Study design: A retrospective case-control study on patients with type 2 diabetes receiving Metformin and diagnosed with lactic acidosis at Phrae Hospital from January 1, 2020, to June 30, 2023
Results: The incidence of MALA from Metformin use was 0.35 (350 per 100,000 cases). Patients with underlying diseases had a higher risk of MALA, including liver disease (AOR=4.53;95%CI=1.81-11.81), chronic heart failure (AOR=5.26;95%CI=3.24-8.55), and chronic obstructive pulmonary disease (AOR=5.06;95%CI=1.53-16.67). eGFR < 60 ml/min/1.73m2 increased the risk by 4.08 times, while eGFR < 45 ml/min/1.73m2 raised it by 8.60 times. MALA patients with pneumonia had a 3.33 times higher risk of death, and lactate levels ≥10 mmol/L increased the mortality risk by 3.06 times
Conclusion: The incidence of MALA in Phrae hospital is 350 cases per 100,000 population. Regular monitoring of diabetic patients taking metformin with underlying diseases or impaired kidney function have a higher risk of MALA. Lactate levels and eGFR, along with appropriate dosage adjustments, can help reduce the risk of MALA-related mortality
Keywords: Metformin, Metformin-associated lactic acidosis (MALA), Type 2 diabetes, Incidence, Risk facter
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