Peri‐operative continuation of metformin does not improve glycaemic control in patients with type 2 diabetes: A randomized controlled trial
Historically, metformin was withheld before surgery for fear of metformin‐associated lactic acidosis. Currently, however, this risk is deemed to be low and guidelines have moved towards the continuation of metformin. We hypothesized that continuing metformin peri‐operatively would lower postoperativ...
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| Veröffentlicht in: | Diabetes, obesity & metabolism obesity & metabolism, 2018-03, Vol.20 (3), p.749-752 |
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| creator | Hulst, A. H. Polderman, J. A. W. Ouweneel, E. Pijl, A. J. Hollmann, M. W. DeVries, J. H. Preckel, B. Hermanides, J. |
| description | Historically, metformin was withheld before surgery for fear of metformin‐associated lactic acidosis. Currently, however, this risk is deemed to be low and guidelines have moved towards the continuation of metformin. We hypothesized that continuing metformin peri‐operatively would lower postoperative serum glucose level without an effect on plasma lactate levels. We performed a single‐blind multicentre randomized controlled trial in people with type 2 diabetes mellitus scheduled for non‐cardiac surgery and continued (MF+ group) or withheld (MF‐ group) metformin before surgery. The main outcome measures were the differences in peri‐operative plasma glucose and lactate levels. We randomized 70 patients (37 MF+ group and 33 MF‐ group) with type 2 diabetes mellitus. Postoperative glucose levels were similar in the MF+ and the MF‐ groups (8.2 ± 1.8 vs 8.3 ± 2.3 mmol/L P = .95) Although preoperative lactate levels were slightly higher in the MF+ group compared with the MF‐ group (1.5 vs 1.2 mmol/L; P = .02), the postoperative lactate levels were not significantly different (1.2 vs 1.0 mmol/L; P = .18). In conclusion, continuation of metformin during elective non‐cardiac surgery does not improve glucose control or raise lactate levels to a clinically relevant degree. |
| doi_str_mv | 10.1111/dom.13118 |
| format | Article |
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H. ; Polderman, J. A. W. ; Ouweneel, E. ; Pijl, A. J. ; Hollmann, M. W. ; DeVries, J. H. ; Preckel, B. ; Hermanides, J.</creator><creatorcontrib>Hulst, A. H. ; Polderman, J. A. W. ; Ouweneel, E. ; Pijl, A. J. ; Hollmann, M. W. ; DeVries, J. H. ; Preckel, B. ; Hermanides, J.</creatorcontrib><description>Historically, metformin was withheld before surgery for fear of metformin‐associated lactic acidosis. Currently, however, this risk is deemed to be low and guidelines have moved towards the continuation of metformin. We hypothesized that continuing metformin peri‐operatively would lower postoperative serum glucose level without an effect on plasma lactate levels. We performed a single‐blind multicentre randomized controlled trial in people with type 2 diabetes mellitus scheduled for non‐cardiac surgery and continued (MF+ group) or withheld (MF‐ group) metformin before surgery. The main outcome measures were the differences in peri‐operative plasma glucose and lactate levels. We randomized 70 patients (37 MF+ group and 33 MF‐ group) with type 2 diabetes mellitus. Postoperative glucose levels were similar in the MF+ and the MF‐ groups (8.2 ± 1.8 vs 8.3 ± 2.3 mmol/L P = .95) Although preoperative lactate levels were slightly higher in the MF+ group compared with the MF‐ group (1.5 vs 1.2 mmol/L; P = .02), the postoperative lactate levels were not significantly different (1.2 vs 1.0 mmol/L; P = .18). In conclusion, continuation of metformin during elective non‐cardiac surgery does not improve glucose control or raise lactate levels to a clinically relevant degree.</description><identifier>ISSN: 1462-8902</identifier><identifier>EISSN: 1463-1326</identifier><identifier>DOI: 10.1111/dom.13118</identifier><identifier>PMID: 28940961</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Acidosis ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antidiabetics ; Blood Glucose - metabolism ; Clinical trials ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - blood ; Diabetes Mellitus, Type 2 - drug therapy ; Evidence-based medicine ; Female ; Glucose ; Heart ; Heart diseases ; Heart surgery ; Humans ; Hypoglycemic Agents - therapeutic use ; Intraoperative Care ; Lactic acid ; Lactic acidosis ; Length of Stay - statistics & numerical data ; Male ; Medication Adherence ; Metformin ; Metformin - therapeutic use ; Middle Aged ; peri‐operative period ; Postoperative Complications - etiology ; Single-Blind Method ; Treatment Outcome ; type 2 ; Young Adult</subject><ispartof>Diabetes, obesity & metabolism, 2018-03, Vol.20 (3), p.749-752</ispartof><rights>2017 John Wiley & Sons Ltd</rights><rights>2017 John Wiley & Sons Ltd.</rights><rights>2018 John Wiley & Sons Ltd</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3538-ca902a9f0e44d0c2dfd0c8b055d0d4d41439f1bfdd07e579a4a421521f1596a13</citedby><cites>FETCH-LOGICAL-c3538-ca902a9f0e44d0c2dfd0c8b055d0d4d41439f1bfdd07e579a4a421521f1596a13</cites><orcidid>0000-0001-9101-7649</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fdom.13118$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fdom.13118$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28940961$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hulst, A. H.</creatorcontrib><creatorcontrib>Polderman, J. A. W.</creatorcontrib><creatorcontrib>Ouweneel, E.</creatorcontrib><creatorcontrib>Pijl, A. J.</creatorcontrib><creatorcontrib>Hollmann, M. W.</creatorcontrib><creatorcontrib>DeVries, J. H.</creatorcontrib><creatorcontrib>Preckel, B.</creatorcontrib><creatorcontrib>Hermanides, J.</creatorcontrib><title>Peri‐operative continuation of metformin does not improve glycaemic control in patients with type 2 diabetes: A randomized controlled trial</title><title>Diabetes, obesity & metabolism</title><addtitle>Diabetes Obes Metab</addtitle><description>Historically, metformin was withheld before surgery for fear of metformin‐associated lactic acidosis. Currently, however, this risk is deemed to be low and guidelines have moved towards the continuation of metformin. We hypothesized that continuing metformin peri‐operatively would lower postoperative serum glucose level without an effect on plasma lactate levels. We performed a single‐blind multicentre randomized controlled trial in people with type 2 diabetes mellitus scheduled for non‐cardiac surgery and continued (MF+ group) or withheld (MF‐ group) metformin before surgery. The main outcome measures were the differences in peri‐operative plasma glucose and lactate levels. We randomized 70 patients (37 MF+ group and 33 MF‐ group) with type 2 diabetes mellitus. Postoperative glucose levels were similar in the MF+ and the MF‐ groups (8.2 ± 1.8 vs 8.3 ± 2.3 mmol/L P = .95) Although preoperative lactate levels were slightly higher in the MF+ group compared with the MF‐ group (1.5 vs 1.2 mmol/L; P = .02), the postoperative lactate levels were not significantly different (1.2 vs 1.0 mmol/L; P = .18). In conclusion, continuation of metformin during elective non‐cardiac surgery does not improve glucose control or raise lactate levels to a clinically relevant degree.</description><subject>Acidosis</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antidiabetics</subject><subject>Blood Glucose - metabolism</subject><subject>Clinical trials</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2 - blood</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Evidence-based medicine</subject><subject>Female</subject><subject>Glucose</subject><subject>Heart</subject><subject>Heart diseases</subject><subject>Heart surgery</subject><subject>Humans</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Intraoperative Care</subject><subject>Lactic acid</subject><subject>Lactic acidosis</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medication Adherence</subject><subject>Metformin</subject><subject>Metformin - therapeutic use</subject><subject>Middle Aged</subject><subject>peri‐operative period</subject><subject>Postoperative Complications - etiology</subject><subject>Single-Blind Method</subject><subject>Treatment Outcome</subject><subject>type 2</subject><subject>Young Adult</subject><issn>1462-8902</issn><issn>1463-1326</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc9uFSEUxomxsbW68AUMiRtdTMsBZu7grql_2qSmLnRNuMNBaWZgBMbmuvIFTHxGn0R6b-uiiSzgkPy-L-fLR8gzYEdQz7GN0xEIgP4BOQDZiQYE7x5uZ970ivF98jjnK8aYFP3qEdnnvZJMdXBAfn3E5P_8_B1nTKb470iHGIoPS_3EQKOjExYX0-QDtREzDbFQP80pVvTLuBkMTn7YilIcaaXmqsRQMr325Sstmxkpp9abNRbMr-kJTSbUhf0PtHeysY4leTM-IXvOjBmf3r6H5PO7t59Oz5qLy_fnpycXzSBa0TeDqZmMcgyltGzg1tW7X7O2tcxKK0EK5WDtrGUrbFfKSCM5tBwctKozIA7Jy51vzfFtwVz05POA42gCxiVrUJJ3qhctr-iLe-hVXFKo22nOGHRScX5DvdpRQ4o5J3R6Tn4yaaOB6ZuOdI2stx1V9vmt47Ke0P4j70qpwPEOuPYjbv7vpN9cfthZ_gUsRp4D</recordid><startdate>201803</startdate><enddate>201803</enddate><creator>Hulst, A. 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H.</au><au>Preckel, B.</au><au>Hermanides, J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Peri‐operative continuation of metformin does not improve glycaemic control in patients with type 2 diabetes: A randomized controlled trial</atitle><jtitle>Diabetes, obesity & metabolism</jtitle><addtitle>Diabetes Obes Metab</addtitle><date>2018-03</date><risdate>2018</risdate><volume>20</volume><issue>3</issue><spage>749</spage><epage>752</epage><pages>749-752</pages><issn>1462-8902</issn><eissn>1463-1326</eissn><abstract>Historically, metformin was withheld before surgery for fear of metformin‐associated lactic acidosis. Currently, however, this risk is deemed to be low and guidelines have moved towards the continuation of metformin. We hypothesized that continuing metformin peri‐operatively would lower postoperative serum glucose level without an effect on plasma lactate levels. We performed a single‐blind multicentre randomized controlled trial in people with type 2 diabetes mellitus scheduled for non‐cardiac surgery and continued (MF+ group) or withheld (MF‐ group) metformin before surgery. The main outcome measures were the differences in peri‐operative plasma glucose and lactate levels. We randomized 70 patients (37 MF+ group and 33 MF‐ group) with type 2 diabetes mellitus. Postoperative glucose levels were similar in the MF+ and the MF‐ groups (8.2 ± 1.8 vs 8.3 ± 2.3 mmol/L P = .95) Although preoperative lactate levels were slightly higher in the MF+ group compared with the MF‐ group (1.5 vs 1.2 mmol/L; P = .02), the postoperative lactate levels were not significantly different (1.2 vs 1.0 mmol/L; P = .18). In conclusion, continuation of metformin during elective non‐cardiac surgery does not improve glucose control or raise lactate levels to a clinically relevant degree.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>28940961</pmid><doi>10.1111/dom.13118</doi><tpages>4</tpages><orcidid>https://orcid.org/0000-0001-9101-7649</orcidid></addata></record> |
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| subjects | Acidosis Adolescent Adult Aged Aged, 80 and over Antidiabetics Blood Glucose - metabolism Clinical trials Diabetes Diabetes mellitus Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - drug therapy Evidence-based medicine Female Glucose Heart Heart diseases Heart surgery Humans Hypoglycemic Agents - therapeutic use Intraoperative Care Lactic acid Lactic acidosis Length of Stay - statistics & numerical data Male Medication Adherence Metformin Metformin - therapeutic use Middle Aged peri‐operative period Postoperative Complications - etiology Single-Blind Method Treatment Outcome type 2 Young Adult |
| title | Peri‐operative continuation of metformin does not improve glycaemic control in patients with type 2 diabetes: A randomized controlled trial |
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