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Q In patients with type 2 diabetes mellitus, what is the risk of fatal and non-fatal lactic acidosis associated with metformin compared with placebo or other glucose lowering therapies? Does metformin increase lactate levels?
Clinical impact ratings GP/FP/Primary care ★★★★★★☆ IM/Ambulatory care ★★★★★★☆ Internal medicine ★★★★★★☆ Endocrine ★★★★★★☆
METHODS
Data sources:
the Cochrane Library, Medline, Reactions, and EMBASE/Excerpta Medica (up to March 2002); references of identified articles and reviews; abstracts of clinical conferences; and authors of relevant studies and manufacturers of metformin.
Study selection and assessment:
randomised controlled trials (RCTs) or cohort studies ⩾1 month in duration that compared metformin, alone or in combination in other treatments, with placebo or another glycaemic lowering intervention for type 2 diabetes. Methodological quality was assessed using criteria that considered randomisation procedure, blinding, and withdrawals and dropouts.
Outcomes:
fatal lactic acidosis, …
Footnotes
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For correspondence: Dr S R Salpeter, Santa Clara Valley Medical Center, San Jose, CA, USA. salpeterstanford.edu
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Source of funding: no external funding.
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Abstract and commentary also appear in ACP Journal Club.