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The prescribing information for metformin carries strong warnings about risk for lactic acidosis, particularly in patients with renal insufficiency or heart failure. In this analysis drawn from the U.K. General Practice Research Database, investigators determined the incidence of lactic acidosis among 50,000 patients with type 2 diabetes who were prescribed any oral antidiabetic agent between 1994 and 2005.
Six cases of lactic acidosis were identified among current users of oral antidiabetic drugs. One patient took metformin only, one took a sulfonylurea only, and four took metformin plus another drug (sulfonylurea or pioglitazone). The crude incidence of lactic acidosis was 3.3 per 100,000 person-years in metformin users and 4.8 per 100,000…