title: Incidence of lactic acidosis in metformin users.
abstract: OBJECTIVE
  The purpose of this study was to determine the incidence of lactic acidosis in a geographically defined population of metformin users.
  
  
  METHODS
  The study was based on a historical cohort from the Saskatchewan Health administrative databases. Individuals with a metformin prescription dispensed between 1980 and 1995 inclusive were eligible for the cohort. Person-years of exposure were calculated. Cases were defined by hospital discharge with a diagnosis of acidosis (International Classification of Diseases, Ninth Revision code: 276.2) and confirmation by chart review of a blood lactate level > or = 5 mmol/l. Death registrations of individuals dying within 120 days of a metformin prescription were also reviewed.
  
  
  RESULTS
  During the study period, 11,797 residents received one or more metformin prescriptions, resulting in 22,296 person-years of exposure. There were 10 subjects who had hospital discharges with a diagnosis of acidosis. However, primary record review revealed only two cases with laboratory findings of elevated blood lactate levels, for an incidence rate of 9 cases per 100,000 person-years of metformin exposure. In both cases, other factors besides metformin could have contributed to the lactic acidosis. No additional cases were found on review of death registrations.
  
  
  CONCLUSIONS
  From 1980 through 1995, the incidence rate of lactic acidosis was 9 per 100,000 person-years (95% CI 0-21) in patients dispensed metformin in Saskatchewan, Canada. This incidence rate was derived from a population with complete ascertainment of hospitalizations and deaths associated with lactic acidosis in metformin users. It is similar to previously published rates based on passive reporting of cases, and it is well below the lactic acidosis rate of 40-64 per 100,000 patient-years in patients prescribed phenformin.
authors.affiliation: Saskatchewan Health, Regina, Canada. mstang@health.gov.sk.ca
authors.forename: M
authors.initials: M
authors.lastname: Stang
authors.forename: D K
authors.initials: DK
authors.lastname: Wysowski
authors.forename: D
authors.initials: D
authors.lastname: Butler-Jones
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced / Q000453:epidemiology*; D015331:Cohort Studies; D019992:Databases as Topic; D003644:Death Certificates; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence; D007773:Lactates / Q000097:blood; D008687:Metformin / Q000627:therapeutic use*; D010629:Phenformin / Q000009:adverse effects; D012042:Registries; D012525:Saskatchewan / Q000453:epidemiology; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D007004:Hypoglycemic Agents; D007773:Lactates; D008687:Metformin; D010629:Phenformin