Elderly patients may have reduced renal function induced by age associated changes ( measurable ) and possible other changes. All these, before comorbid conditions and polypharmacy. Please share your experience and opinion regarding the use of Metphormin as treatment of Diabetes mellitus in old age ?
As a clinical endocrinologist I use metformin in many patients but I always try to respect guidelines.
HOWEVER, I see through the duties patients coming with serious and severe conditions. In spite of all theoretical dramatic risks of lactic acidosis, I haven't seen any lactic acidosis for years, even in elderly!!!
The rare lactic acidosis occur in a combination of numerous risk factors.
I think one has to use low dose in elderly patient with no specific risk factors, and to avoid this molecule in case of risk factors (until we have more information on safety)...
I'm working in a primary care setting. I'm using metformin as the first line treatment in a wide range of patients, including elderly and pluripathologic patients, unless they have a deteriorated renal function. I have not a perception that metformine may be a hazardous drug for older people (not more than any other drugs for diabetes)
According to litterature, metformin could theoretically be safe until 30 ml/mn clairance, so...
But take care of creatinine value in elderly (denutrition...)
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