Journal of the Chinese Medical Association
Volume 73, Issue 12 , Pages 617-622, December 2010

Fasting Plasma Lactate Concentrations in Ambulatory Elderly Patients With Type 2 Diabetes Receiving Metformin Therapy: A Retrospective Cross-sectional Study

  • Yi-Chun Lin

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, and National Yang-Ming University, Taipei, Taiwan, R.O.C.
    • School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Liang-Yu Lin

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, and National Yang-Ming University, Taipei, Taiwan, R.O.C.
    • Department and Institute of Pharmacology, Taiwan, R.O.C.
    • ,
  • Huei-Fang Wang

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Medicine, Saint Mary's Hospital, Luodong, Yilan, Taiwan, R.O.C.
    • ,
  • Hong-Da Lin

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, and National Yang-Ming University, Taipei, Taiwan, R.O.C.
    • School of Medicine, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Hong-Da Lin, Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.

Received 29 April 2010; accepted 30 July 2010.

Article Outline

Background

Metformin is a worldwide accepted biguanide antidiabetic agent, and its effectiveness and benefit have already been well established. Among the side effects of metformin, lactate acidosis is the most problematic because of a high mortality rate, which impedes its use in clinical practice, especially in elderly patients with type 2 diabetes. Aging is associated with a decreased renal function and increasing comorbidities, but few data are available regarding plasma lactate levels in this unique population. In this study, we assessed fasting plasma lactate levels in ambulatory, elderly Taiwanese patients with type 2 diabetes, who were taking the drug, metformin, to identify independent risk factors for hyperlactemia in this group.

Methods

Sixty-six ambulatory type 2 diabetic patients, > 80 years of age (mean, 83.6 years; range, 80-90 years), receiving metformin therapy, were enrolled, from January 2005 to September 2009, in the Diabetes Case Management Program. A further 79 younger patients (also type 2 diabetics on metformin) served as controls (mean age, 59.9 years; range, 37-79 years). Fasting serum electrolytes, creatinine, bicarbonate, glycated hemoglobin, plasma glucose and lactate levels were determined.

Results

Lactate levels did not differ between the elderly and control groups (13.2 +/− 5.2 mg/dL and 13.5 +/− 4.8 mg/dL, respectively). None of the patients fulfilled the lactic acidosis criteria. Patients in the elderly group had a significantly lower daily metformin dose, higher creatinine levels, and lower estimated creatinine clearance, compared with the control group (all p < 0.05). Estimated creatinine clearance was negatively associated with lactate levels in the elderly group (p < 0.05, r = −0.27), but not in the control group. Patients with fasting plasma glucose levels > 130 mg/dL had a 2.8-fold increased risk of developing hyperlactemia.

Conclusion

Plasma lactate levels in ambulatory elderly patients with type 2 diabetes receiving metformin therapy did not differ from those in a younger age group. Patients with fasting plasma glucose levels > 130 mg/dL had a 2.8-fold risk of developing hyperlactemia, but none of them developed lactate acidosis.

Key Words:  elderly , lactate , metformin , type 2 diabetes

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PII: S1726-4901(10)70135-0

doi:10.1016/S1726-4901(10)70135-0

Journal of the Chinese Medical Association
Volume 73, Issue 12 , Pages 617-622, December 2010

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