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Metformin advice flouted

NICE guidance on discontinuing treatment with metformin in diabetic patients with renal impairment is being widely flouted, an audit reveals.

NICE guidance on discontinuing treatment with metformin in diabetic patients with renal impairment is being widely flouted, an audit reveals.

Of 694 patients prescribed the drug, 42 were found to have creatinine levels above 130µmol/l which NICE says should contraindicate use.

The researchers, who presented the results at the Diabetes UK conference, said their findings highlighted widespread confusion and local variation in guidance.

Dr Rajagopalan Pradeep, registrar in diabetes at Milton Keynes NHS Trust who carried out the audit, said: 'Some people said they are using 180, some 150. It varies region to region.

'NICE advice is for people to have creatinine measured once a year but if it goes up what are the options? There lies the problem.'

Dr Mark Browne, a GP in Derby and diabetes lead for Greater and Central Derby PCTs, said: 'What I try and tell local practices is I start to get concerned as it's creeping up towards 130.'

He added: 'Your creatinine as a measure is a bit of a blunderbuss. I also look at the eGFR. If this dropped from 80 to 50 you should think about stopping.'

Dr Colin Kenny, member of the Primary Care Diabetes Society and a GP in Northern Ireland, said: 'I would think 130 is a bit low. Metformin is a dangerous drug, but it is very effective.'

Dr Pradeep added that a higher threshold was also generally used in Scotland.

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