Intervención farmacéutica en la prescripción de metformina en pacientes con diabetes mellitus tipo 2 e insuficiencia renal

Objective

To implement a pharmaceutical care program for hospitalized patients with moderate to severe renal insufficiency treated with metformin and to analyze the impact of pharmaceutical intervention in its prescribing.

Material and method

Prospective intervention study developed in a general hospital of 1,080 beds over a 2.5 month period. An algorithm was designed in order to use metformin depending on creatinine clearance. In patients suffering from severe renal insufficiency the pharmaceutical intervention was to recommend the discontinuation of the drug, while for moderate insufficiency other factors were considered. The degree of acceptance of the pharmaceutical intervention was calculated, and whether there was any episode of metformin-induced lactic acidosis.

Results

Renal insufficiency (16.1-59.8 ml/min creatinine clearance) was observed in 11.5% of the patients taking metformin. Almost two-thirds (65.3%) of them had other comorbidities that also contraindicated the use of metformin. Acceptance of pharmaceutical interventions was 65.7%, reaching 80% if the patient suffered from severe renal impairment.

Conclusions

The implementation of a pharmaceutical care program for diabetic patients with moderate to severe renal insufficiency using metformin resulted in the safe use of the drug. The degree of acceptance of the pharmaceutical interventions was good and there were no episodes of metformin-induced lactic acidosis.