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Review: metformin does not increase fatal or non-fatal lactic acidosis or blood lactate concentrations in type 2 diabetes mellitus

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 QUESTION: In patients with type 2 diabetes mellitus, does metformin increase the risk for fatal and non-fatal lactic acidosis or increase blood lactate concentrations compared with placebo or other hypoglycaemic treatments?

Data sources

Studies were identified by searching the Cochrane Library (to April 2000), Medline (1966–2000), EMBASE/Excerpta Medica (1974–2000), Oldmedline, Reactions (1983 to May 2000), Index Medicus (1959–1965), and bibliographies of identified papers and by contacting investigators.

Study selection

Clinical trials and cohort studies were selected if they included patients with type 2 diabetes, lasted ≥1 month, compared metformin alone or combined with other treatments with placebo or any other hypoglycaemic treatment, and reported the number of patients and duration of treatment.

Data extraction

Data were extracted on study methods and quality, participants, interventions, and outcomes. Attempts were made to contact authors for missing data.

Main results

176 studies (118 prospective …

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