LBODP033 The Compliant Patient - When Adherence Hurts

Metformin is a biguanide oral antidiabetic agent which lowers blood glucose by decreasing hepatic gluconeogenesis. In the absence of contraindications, it is the initial treatment in most patients with type 2 diabetes along with lifestyle modifications. This drug however is commonly associated with gastrointestinal side effects especially diarrhoea which could be potentially life-threatening if prolonged. We report a case of chronic severe painless diarrhoea with weight loss over 8 months in a 40-year-old man after starting metformin for his newly diagnosed type 2 diabetes. Although the diarrhoea resolved when the patient temporarily stopped taking metformin, he decided to resume the medication to ensure his blood glucose is optimally controlled. He suspected metformin to be the cause of his diarrhoea but did not report this to his doctor during follow-up. The patient was later admitted for hypovolemic shock and severe metabolic acidosis with acute kidney injury when his diarrhoea worsened with acute gastroenteritis. He required mechanical ventilation, inotropic support and Continuous Renal Replacement Therapy in the ICU. This was further complicated by left eye ischemic optic neuropathy attributed to the acute volume loss as radiological investigations were unremarkable. Multiple laboratory and radiological investigations were done to look for the cause of the diarrhoea with no underlying pathology found. Metformin was discontinued upon admission and his diarrhoea subsequently resolved 8 days later. Upon follow-up a month later, the patient continued to be diarrhoea free without metformin. This case highlights the importance of patient education on the side effects of a medication like metformin upon commencement of the drug and to encourage the patient to notify their healthcare provider timely if they experience those side effects. This not only empowers patients to participate in their own healthcare but would avoid severe drug-related adverse events that can result in unwanted long-term sequelae. Presentation: No date and time listed