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Metformin-associated Lactic Acidosis with Hypoglycemia during the COVID-19 Pandemic

Kana Takayama1, Yoshinari Obata1, Yumiko Maruo1

  • 1Department of Diabetes, Metabolism and Endocrinology, Osaka Police Hospital, Japan.

Internal Medicine (Tokyo, Japan)
|May 22, 2022
PubMed

Insights

Metformin-associated lactic acidosis (MALA) is a rare but severe risk of metformin. COVID-19 pandemic lifestyle changes, like increased alcohol intake, may heighten MALA risk in diabetic patients.

Area of Science:

  • Endocrinology
  • Pharmacology
  • Critical Care Medicine

Background:

  • Metformin is a widely prescribed oral hypoglycemic agent for type 2 diabetes.
  • Metformin-associated lactic acidosis (MALA) is a rare but potentially fatal adverse drug reaction.
  • The COVID-19 pandemic introduced lifestyle changes that could impact medication safety.

Observation:

  • A 64-year-old Japanese male patient on a low-dose metformin regimen presented with MALA.
  • The patient also experienced hypoglycemia concurrently with MALA.
  • Increased alcohol consumption, linked to pandemic-related lifestyle shifts, was identified as a trigger.

Findings:

  • This case highlights a rare instance of MALA and hypoglycemia in a patient on low-dose metformin.
  • The patient's increased alcohol intake, a consequence of pandemic lifestyle changes, precipitated the adverse event.
  • This suggests a potential interaction between metformin, alcohol, and pandemic-induced behavioral changes.

Implications:

  • Physicians must exercise caution when prescribing metformin, especially in patients susceptible to lifestyle changes.
  • Close monitoring of patients on metformin is crucial during periods of significant lifestyle alteration, such as pandemics.
  • Awareness of potential triggers like increased alcohol consumption is vital for preventing MALA during the COVID-19 pandemic.
Keywords:
COVID-19alcoholhypoglycemialactic acidosismetformin

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