Exp Clin Endocrinol Diabetes 2012; 120(03): 152-153
DOI: 10.1055/s-0031-1285911
Short Communication
© J. A. Barth Verlag in George Thieme Verlag KG Stuttgart · New York

Metformin after Bariatric Surgery – an Acid Problem

J. Aberle
1   Universitätsklinikum Hamburg – Eppendorf, Sektion Endokrinologie und Diabetologie, Interdisziplinäres Adipositaszentrum, Hamburg
,
F. Reining
1   Universitätsklinikum Hamburg – Eppendorf, Sektion Endokrinologie und Diabetologie, Interdisziplinäres Adipositaszentrum, Hamburg
,
V. Dannheim
1   Universitätsklinikum Hamburg – Eppendorf, Sektion Endokrinologie und Diabetologie, Interdisziplinäres Adipositaszentrum, Hamburg
,
J. Flitsch
1   Universitätsklinikum Hamburg – Eppendorf, Sektion Endokrinologie und Diabetologie, Interdisziplinäres Adipositaszentrum, Hamburg
,
A. Klinge
2   Gemeinschaftspraxis für Innere Medizin und Diabetologie, Hamburg
,
O. Mann
3   Universitätsklinikum Hamburg – Eppendorf, Klinik Allgemein-, Viszeral- und Thoraxchirurgie, Interdisziplinäres Adipositaszentrum, Hamburg
› Author Affiliations
Further Information

Publication History

received 06 July 2011
first decision 28 July 2011

accepted 29 July 2011

Publication Date:
13 September 2011 (online)

Abstract

Metformin is the oral drug of first choice in type 2 diabetes. Therefore a large number of patients undergoing bariatric surgery will be on Metformin treatment. However, use of Metformin has been associated with lactate acidosis. Weight loss following bariatric surgery is most pronounced during the first weeks after the operation and this creates a phase of negative energy balance with ketone body formation. To shed more light on this situation we measured ketone bodies in 90 patients 5 days–18 months after bariatric surgery. Ketone bodies were markedly elevated during the first 3–4 months. Metformin use should therefore be critically reconsidered after bariatric operations.

 
  • References

  • 1 American Diabetes Association . Standards of medical care in diabetes – 2011 Diabetes Care 2011; 34 (Suppl. 01) S11-S61
  • 2 Meijer RI, van Wagensveld BA, Siegert CE et al. Bariatric surgery as a novel treatment for type 2 diabetes mellitus: a systematic review. Arch Surg 2011; 146 (06) 744-750
  • 3 Peterli R, Wölnerhanssen B, Peters T et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg 2009; 250 (02) 234-241
  • 4 Hamza N, Abbas MH, Darwish A et al. Predictors of remission of type 2 diabetes mellitus after laparoscopic gastric banding and bypass. Obes Relat Dis 2010; [Epub ahead of print]
  • 5 Misbin RI, Green L, Stadel BV et al. Lactic acidosis in patients with diabetes treated with metformin New Engl J Med 1998; 338 (04) 265-266
  • 6 Wiholm BE, Myrhed M. Metformin-associated lactic acidosis in Sweden 1977–1991. Eur J Clin Pharmacol 1993; 44 (06) 589-591
  • 7 van Berlo-van de Laar IR, Vermeij CG, Doorenbos CJ. Metformin associated lactic acidosis: incidence and clinical correlation with metformin serum concentration measurements. J Clin Pharm Ther 2011; 36 (03) 376-382 doi: DOI: 10.1111/j.1365-2710.2010.01192.x.. Epub 2010 Aug 25
  • 8 Glucophage 500/850/100. Drug Information. Merck Serono GmbH. Darmstadt. Germany
  • 9 Salpeter SR, Greyber E, Pasternak GA et al. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev 2010; (04) CD002967. Review
  • 10 Stang M, Wysowski DK, Butler-Jones D. Incidence of lactic acidosis in metformin users. Diabetes Care 1999; (06) 925-927