Metformin in Type 1 Diabetes
Is this a good or bad idea?
- J. David Faichney, MD, FACP and
- Philip W. Tate, MD
- From the Center for Diabetes and Endocrinology, Saint Mary’s Mercy Medical Center, Grand Rapids, Michigan
The article by Meyer et al. (1) revives a debate regarding the appropriateness of metformin use for people with type 1 diabetes. Given the potential for coexisting lactic acidosis and diabetic ketoacidosis, how can one justify its use? Indeed, there was little reason to expect a benefit in patients who were studied: nonobese type 1 diabetic subjects with HbA1c <9.0% who were taking ∼0.7 units · kg insulin−1 · day−1. A modest average reduction of daily insulin requirements, 4.3 units, as compared with an increase of 1.7 units for placebo, does not seem to be worth the trade-off of increased risk for severe hypoglycemia (19 events in …
