Bobby Lazzara, MD


There is a dearth of evidence to support the omission of metformin during illnesses that may increase the risk of acute kidney injury (AKI), a need that led the current authors to examine the relationship between AKI, lactate concentrations, and risk of lactic acidosis in individuals taking metformin.

Their paper, recently published in the journal 

, reported results of a population-based case control study of metformin use, and lactic acidosis in patients with type 2 diabetes.

The study found a definite association between metformin, lactate accumulation, and the development of lactic acidosis-in fact, individuals treated with metformin were more than twice as likely to develop the condition vs non-metformin treated persons with or without diabetes. The association was strongest in those patients with AKI.

The authors concluded the evidence supports the recommendation to omit metformin in any disease state that may cause acute renal insuffiency.

: Connelly PJ, Lonergan M, Soto-Pedre E, et al.

 Acute kidney injury, plasma lactate concentrations and lactic acidosis in metformin users: A GoDarts study. 

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In 2016, the European Society of Endocrinology (ESE), in collaboration with the European Network for the Study of Adrenal Tumors, asserted that adrenal incidentalomas <4 cm and ≤10 Hounsfield units do not require follow-up imaging.

reports results of a study designed specifically to assess the application of the recommended follow up strategies.

The retrospective cohort study looked at clinical characteristics and natural course of incidental adrenal masses in a single center over 13 years in more than 1000 patients.

The authors conclusions helped validate recommendations from the ESE that no follow up imaging is needed for adrenal masses less than 4 cm that have clearly benign features.

Source: Hong AR, Kim JH, Park KS, et al. 

Optimal follow-up strategies for adrenal incidentalomas: reappraisal of the 2016 ESE-ENSAT guidelines in real clinical practice

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To image or not to image: A new study validates professional society recommendations on follow-up strategies for adrenal masses. 

Video: How to Follow an Adrenal Incidentaloma 

A randomized placebo-controlled trial published in the 

examined the effect of probiotics on gestational diabetes.

The trial compared 212 pregnant women between 14 and 16 weeks of gestation who received a lactobacillus probiotic with 211 who did not.

Patients receiving the probiotic had a lower prevalence of gestational diabetes, including women with a previous history. There was also an absence of serious maternal or post-birth adverse events.

The authors stated probiotics may be an inexpensive and safe intervention to combat the prevalence of gestational diabetes.

A randomized placebo controlled trial examined the effect of probiotics on gestational diabetes.

Effect of Probiotics on Gestational Diabetes

Journal of Evaluation of Clinical Practice

nurse-guided interventions can improve control of HbA1c in patients with type 2 diabetes.

The study looked at adults with type 2 diabetes and elevated hemoglobin A1c levels. Patients were randomized to standard care, nurse-led education intervention, or nurse-led education plus acceptance therapy.

Nurse-led intervention groups had significant reductions in hemoglobin A1c levels compared with the control group.

When it comes to managing chronic conditions like type 2 diabetes, nurse-led education as an adjunct treatment may make a big difference.

Patients were randomized to standard care, nurse-led education intervention, or nurse-led education plus acceptance therapy.

Diabetes Self-Management: Nurse-Led Approach

compared the renal side effects of SGLT2 inhibitors.

Randomized trials in patients with T2DM receiving SGLT2 inhibitors and experiencing at least one adverse renal outcome were included.

The results indicated dapagliflozin was associated with a greater risk of composite adverse renal events compared with placebo, and only empagliflozin was associated with a lower risk than placebo. More research is needed by the authors concluded that empagliflozin may have a renal-protective effect.

A meta-analysis compared the renal side effects of SGLT2 inhibitors in patients with type 2 diabetes.

Renal Effects: SGLT2 Inhibitors in Type 2 Diabetes

A retrospective cohort study published in 

 sought to look at the association between insulin dose and mortality and major adverse cardiovascular events in patients with T2DM.

The study was drawn from primary care records from the UK-based Clinical Practice Research Datalink that identified new users of metformin and those who had a new prescription for insulin.

According to the authors, the take-home message is, “The result from the study reassures both patients and physicians of the overall safety and absence of major cardiovascular harms of insulin in the treatment of type 2 diabetes.”

A study compared mortality and major adverse cardiovascular events in patients with type 2 diabetes prescribed metformin or insulin.