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Obesity Surgery

, Volume 28, Issue 4, pp 1080–1085 | Cite as

Risk of Metformin-Associated Lactic Acidosis (MALA) in Patients After Gastric Bypass Surgery

  • Laura N. Deden
  • Edo O. Aarts
  • Stephanie C. W. Aelfers
  • Marcel M. G. J. van Borren
  • Ignace M. C. Janssen
  • Frits J. Berends
  • Hans de Boer
Original Contributions

Abstract

Background

Pharmacokinetic data suggest that the risk of metformin-associated lactic acidosis (MALA) may be increased after Roux-en-Y gastric bypass (RYGB) surgery. The aim of this study was to examine the impact of metformin on plasma lactate levels before and after RYGB surgery.

Methods

Retrospective study of plasma lactate levels before and 3 months after RYGB surgery in patients with type 2 diabetes mellitus (T2DM) not using metformin (MET-0, N = 58), on a stable dose (MET-S, N = 138), or on a decreasing dose (MET-D, N = 85) of metformin.

Results

Preoperatively, lactate levels were similar in patients on metformin (1.8 ± 0.05 mmol/L) and those not on metformin (1.7 ± 0.08 mmol/L), P = 0.21. Three months postoperatively, lactate levels had decreased in all groups (P < 0.001) to 1.3 ± 0.07 (SE), 1.4 ± 0.05, and 1.2 ± 0.05 mmol/l in MET-0, MET-S, and MET-D, respectively. Lactate levels differed between the groups (P = 0.03), with the lowest level in MET-D. The number of patients with hyperlactatemia (lactate > 2 mmol/l) decreased from 31 to 14%, from 22 to 8.6%, and from 26 to 4.7% in MET-S, MET-0, and MET-D, respectively.

Conclusion

Mild hyperlactatemia (lactate > 2 mmol/l) is common in morbidly obese patients with T2DM. It is probably related to increase lactate production by adipocytes. Lactate levels decreased after RYGB-induced weight loss, irrespective of the use of metformin. We therefore conclude that there is no need for routinely lowering of the metformin dose after uncomplicated RYGB surgery, as long as normal renal function is preserved.

Keywords

Gastric bypass (RYGB) Obesity Metformin-associated lactic acidosis (MALA) 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent Statement

Does not apply.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Laura N. Deden
    • 1
    • 2
  • Edo O. Aarts
    • 1
    • 2
  • Stephanie C. W. Aelfers
    • 1
    • 2
  • Marcel M. G. J. van Borren
    • 3
  • Ignace M. C. Janssen
    • 1
    • 2
  • Frits J. Berends
    • 1
    • 2
  • Hans de Boer
    • 4
  1. 1.Department of SurgeryRijnstate HospitalArnhemThe Netherlands
  2. 2.Vitalys ClinicVelpThe Netherlands
  3. 3.Department of Clinical ChemistryRijnstate HospitalArnhemThe Netherlands
  4. 4.Departments of Internal MedicineRijnstate HospitalArnhemThe Netherlands

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