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Phenformin-associated metabolic acidosis

M Fulop, H D Hoberman

    Diabetes
    |April 1, 1976
    PubMed
    Summary

    Phenformin treatment in diabetic patients can lead to severe metabolic acidosis, including lactic acidosis and ketoacidosis. This study questions the safety of phenformin due to these serious adverse events.

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    Area of Science:

    • Endocrinology
    • Metabolic Disorders
    • Pharmacology

    Background:

    • Phenformin is an oral antihyperglycemic agent used for type 2 diabetes.
    • Metabolic acidosis is a serious complication that can arise in patients treated with phenformin.

    Purpose of the Study:

    • To investigate the occurrence and characteristics of metabolic acidosis in diabetic patients treated with phenformin.
    • To evaluate the association between phenformin use and adverse metabolic complications.

    Main Methods:

    • Retrospective analysis of 18 consecutive diabetic patients admitted with metabolic acidosis.
    • Assessment of lactic acidosis and ketoacidosis markers, including plasma 3-hydroxybutyrate levels.
    • Correlation of survival with clinical factors such as shock and severity of lactic acidosis.

    Main Results:

    • All 18 patients presented with metabolic acidosis, including lactic acidosis and coexisting ketoacidosis (average plasma 3-hydroxybutyrate 7.1 mmol/L).
    • Most patients did not have marked hyperglycemia, necessitating insulin and glucose treatment.
    • Survival correlated with the absence of shock; 10 patients had no identifiable cause for illness other than phenformin treatment.

    Conclusions:

    • Phenformin treatment is associated with a high incidence of severe metabolic acidosis (lactic acidosis and ketoacidosis).
    • The findings raise significant concerns regarding the safety and continued use of phenformin in diabetic patients.
    • Management should consider insulin and glucose due to potential hypoglycemia and hyperglycemia.

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