European Journal of Biomedical and Pharmaceutical Sciences

ASSESSMENT OF THE EFFECTIVENESS AND SAFETY OF METFORMIN ON EGFR IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND CHRONIC KIDNEY DISEASE

Elmabruk Abdullah Gamag*, Abdu-Alhameed A. Ali Azzwali, Aya Alshershary, Reham Almahrog, Hadeel Alharizi and Sondos Alhomri

ABSTRACT

Background: Metformin hydrochloride is an hypoglycaemic drug that controls the level of blood glucose. It has been recognized as the first line of treatment for type 2 diabetic patients. Increasing burden on using metformin in patients with chronic kidney disease (CKD). Patients with CKD are at high risk of cardiovascular disease and mortality and they may benefit from using metformin as it improves cardiovascular outcomes and reduce mortality. However, current guideline  restrict the use of metformin due to the risk of lactic acidosis. Objectives: The aim of our study was to examine the effectiveness and safety of metformin on kidney function in patients with CKD and type 2 diabetes mellitus and to evaluate the strength of evidence that prefers using metformin in patients with CKD over other glucose lowering agents. Materials and Methods: 133 type 2 diabetes mellitus patients with or without CKD were included for both sex (56 males and 77 females). Results: The results showed that 76.69% were diabetic for less than 5 years, 6.1% were diabetic for 5-10 years, and 17.29% were diabetic for more than 10 years. 41.35% of patients had (>6.5) HbA1C, whereas 58.64% had (˃6.5) HbA1C. 36% of patients were treated with metformin and 24% treated with insulin, and 39.9% treated with other hypoglycemic agents. Metformin used twice a day by (33.33%) of patients and once per day by (66.66%) of patients. 68.42% of the patients have EGFR <90 mL/min/1.73m2, 22.55% have EGFR 60-90mL/min/1.73m2, and 9.02% have EGFR 45.59 mL/min/1.73m2. Patients of more than 60 years old showed a lower EGFR level 92.1 mL/min/1.73m2 than those of less than 60 years old 117 mL/min/1.73m2. Duration of diabetes in patients of more than 10 years showed the lowest estimation of EGFR 89.1 mL/min/1.73m2 compared to the duration of DM 5-10 (108.7 mL/min/1.73m2) and less than 5 years (119.4 mL/min/1.73m2) respectively. HbA1C was controlled in 41.35% of patients with EGFR level 119.2 mL/min/1.73m2, while the uncontrolled HbA1C was in 58.64% of patients with EGFR 96.1 mL/min/1.73m2. EGFR level in metformin treated patients was 91.7 compared patients treated with insulin, and other hypoglycemic agents 114.2mL/min/1.73m2, 103.4mL/min/1.73m2 respectively. Patients on metformin twice daily exhibit a lower EGFR level 93.3 mL/min/1.73m2 compared to those using metformin once per day. Conclusion: The results of our study clearly indicates that EGFR level significantly influenced by dose frequency, diabetic duration and age despite being not fall much below normal level. It can be concluded that EGFR level was lower in metformin treated patients compared to patients on insulin or other hypoglycemic agents.

Keywords: The effectiveness and safety of metformin, kidney function, CKD, type 2 diabetes mellitus.