DM Full Guideline (2010) - VA/DoD Clinical Practice Guidelines Home

Version 4.0
VA/DoD Clinical Practice Guideline
for the Management of Diabetes Mellitus
Biguanides
Metformin
Metformin XR
1.0-2.0% Negligible
risk as
monotherapy
• Use well-established
• May restore ovulation in
premenopausal anovulatory
females
• Monitor renal function prior to
and at least annually thereafter
• Weight neutral or slight weight
loss
• Decrease LDL-C
• Contraindicated in:
o Renal dysfunction (serum
creatinine ≥ 1.5mg/dL
[males]; ≥ 1.4mg/dL
[females] or abnormal
creatinine clearance ,
30ml/min)
o Acute or chronic metabolic
acidosis
• Temporarily discontinue
metformin at the time of or prior
to intravascular iodinated radio
contrast studies and withhold for
48 hours after the procedure.
Reinstitute only after renal
function has been reevaluated and
found to be normal.
• Temporarily discontinue for
surgical procedures (except minor
procedures not associated with
restricted intake of food or fluids).
Do not restart until oral intake has
resumed and renal function has
been evaluated as normal.
• Do not use if patient is ≥80 years
of age unless measurement of
creatinine clearance demonstrates
that renal function is not reduced;
do not titrate to maximum dose.
• In general, avoid metformin in
patients with clinical or laboratory
evidence of hepatic disease
• Patients should be warned against
excessive acute or chronic alcohol
use.
• Discontinue metformin in the
presence of cardiovascular
collapse
• Patients with unstable or acute
congestive heart failure who are at
risk of hypoperfusion and
hypoxemia are at increased risk of
lactic acidosis
• Inexpensive
• Potential for lactic
acidosis when used
in patients for whom
the drug is
contraindicated
• Transient doserelated
GI symptoms
(nausea, vomiting,
bloating, flatulence,
anorexia)
• Decrease in vitamin
B12 levels
Module G: Glycemic Control: Appendices Page 82