Contraindications to use of metformin

摘要: Editor—Jones et al criticise current guidelines highlighting possible contraindications to the use of metformin as too vague and potentially leading underuse in patients with type 2 diabetes.1 Although their desire for a “less ambiguous” approach seems sensible, own still lack clarity. They note that any specific value serum creatinine concentration chosen cut-off point prescribing will be arbitrary because variations muscle mass protein turnover. Despite this they then select—for undefined reasons—a 150 μmol/l guideline. They say caution should therefore used elderly patients. This is statement, which could interpreted meaning not prescribed at all people, specialist opinion sought or clearance calculated before it prescribed, renal function lactate monitored after prescribed.2 In addition, authors do define elderly. Given growing majority diabetes are over 65 there already evidence undertreatment such patients,3 particularly desirable clear about age group if full benefits treatment attained. Although simple formulas can estimate completely reliable,4 may preferable prescription related clearance, takes into account patient's age, rather than alone.