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Provider Decisions and Patient Outcomes After Premature Metformin Discontinuation

The purpose of this study was to evaluate the effects of alternative antihyperglycemic therapy after discontinuation of metformin due to documented declining renal function. This retrospective, single-site study evaluated patients who had metformin discontinued between 1 January 1999 and 30 Septembe...

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Autores principales: Bradley, Jessica N., Edwards, Krystal L., Gunter, Jennifer T., Weideman, Rick A., Kelly, Kevin C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Diabetes Association 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5309901/
https://www.ncbi.nlm.nih.gov/pubmed/28270711
http://dx.doi.org/10.2337/ds15-0049
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author Bradley, Jessica N.
Edwards, Krystal L.
Gunter, Jennifer T.
Weideman, Rick A.
Kelly, Kevin C.
author_facet Bradley, Jessica N.
Edwards, Krystal L.
Gunter, Jennifer T.
Weideman, Rick A.
Kelly, Kevin C.
author_sort Bradley, Jessica N.
collection PubMed
description The purpose of this study was to evaluate the effects of alternative antihyperglycemic therapy after discontinuation of metformin due to documented declining renal function. This retrospective, single-site study evaluated patients who had metformin discontinued between 1 January 1999 and 30 September 2013. Medical records were evaluated for documented adverse events, subsequent glycemic control, and costs associated with the alternative therapy. Patients served as their own controls. A total of 179 patients met study entry criteria, and their peak A1C was significantly higher within the year after metformin discontinuation (P <0.001). After the provider added new medications to control patients’ blood glucose, their A1C by the end of the first year after discontinuing metformin was similar to their A1C while taking metformin. Significant weight gain accompanied the use of the medications added to replace metformin, with an average increase of 3.81 kg (P <0.001). Additionally, after discontinuing metformin, more patients experienced hypoglycemia with the addition of other medications to control their blood glucose (P <0.001). As expected, the cost of therapy was significantly higher (P <0.0001) after metformin was discontinued because metformin was generically available, whereas the replacement medications frequently were not. Providers should consider the expanded recommendations for the use of metformin in patients with mild to moderate stable renal dysfunction to help such patients avoid weight gain, hypoglycemia, loss of blood glucose control, and increased costs.
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spelling pubmed-53099012018-02-01 Provider Decisions and Patient Outcomes After Premature Metformin Discontinuation Bradley, Jessica N. Edwards, Krystal L. Gunter, Jennifer T. Weideman, Rick A. Kelly, Kevin C. Diabetes Spectr Feature Articles The purpose of this study was to evaluate the effects of alternative antihyperglycemic therapy after discontinuation of metformin due to documented declining renal function. This retrospective, single-site study evaluated patients who had metformin discontinued between 1 January 1999 and 30 September 2013. Medical records were evaluated for documented adverse events, subsequent glycemic control, and costs associated with the alternative therapy. Patients served as their own controls. A total of 179 patients met study entry criteria, and their peak A1C was significantly higher within the year after metformin discontinuation (P <0.001). After the provider added new medications to control patients’ blood glucose, their A1C by the end of the first year after discontinuing metformin was similar to their A1C while taking metformin. Significant weight gain accompanied the use of the medications added to replace metformin, with an average increase of 3.81 kg (P <0.001). Additionally, after discontinuing metformin, more patients experienced hypoglycemia with the addition of other medications to control their blood glucose (P <0.001). As expected, the cost of therapy was significantly higher (P <0.0001) after metformin was discontinued because metformin was generically available, whereas the replacement medications frequently were not. Providers should consider the expanded recommendations for the use of metformin in patients with mild to moderate stable renal dysfunction to help such patients avoid weight gain, hypoglycemia, loss of blood glucose control, and increased costs. American Diabetes Association 2017-02 /pmc/articles/PMC5309901/ /pubmed/28270711 http://dx.doi.org/10.2337/ds15-0049 Text en © 2017 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0 for details.
spellingShingle Feature Articles
Bradley, Jessica N.
Edwards, Krystal L.
Gunter, Jennifer T.
Weideman, Rick A.
Kelly, Kevin C.
Provider Decisions and Patient Outcomes After Premature Metformin Discontinuation
title Provider Decisions and Patient Outcomes After Premature Metformin Discontinuation
title_full Provider Decisions and Patient Outcomes After Premature Metformin Discontinuation
title_fullStr Provider Decisions and Patient Outcomes After Premature Metformin Discontinuation
title_full_unstemmed Provider Decisions and Patient Outcomes After Premature Metformin Discontinuation
title_short Provider Decisions and Patient Outcomes After Premature Metformin Discontinuation
title_sort provider decisions and patient outcomes after premature metformin discontinuation
topic Feature Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5309901/
https://www.ncbi.nlm.nih.gov/pubmed/28270711
http://dx.doi.org/10.2337/ds15-0049
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