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Study Reverses Current Thought on Treatment of Cirrhosis

Mayo Clinic team finds metformin safe to use

Researchers at the Mayo Clinic in Rochester, Minnesota, have released a new study that reverses current thought on the treatment of cirrhotic patients with type-2 diabetes.

The study found that the continuation of metformin after a diagnosis of cirrhosis improved survival rates among diabetes patients. Metformin is usually discontinued once cirrhosis is diagnosed because of concerns about an increased risk of adverse effects associated with this treatment in patients with liver impairment.

The study was published in Hepatology.

Merformin is used to treat high blood sugar levels caused by type-2 diabetes. This type of diabetes works in two ways. First, it inhibits the pancreas from producing sufficient insulin, which normally regulates the movement of glucose into cells. Glucose is the body’s main source of fuel. Second, in type-2 diabetes the liver, muscle, and fat tissues become more resistant to the effects of insulin. The combination of decreased insulin production and insulin resistance results in an abnormally high level of glucose in the blood.

Obesity-related fatty liver disease can lead to liver inflammation and cirrhosis, and it is also associated with diabetes. Therefore, type-2 diabetes is found in 37% of cirrhotic patients — five times more than in those without cirrhosis.

In the new study, 172 patients with a diagnosis of cirrhosis continued taking metformin, while another 78 patients discontinued the treatment. Patients who continued metformin as part of their therapy had a significantly longer median survival compared with those who stopped taking the drug. During follow-up, it was discovered that none of the patients taking metformin developed lactic acidosis, which was thought to be a common side effect of the drug in patients with cirrhosis.

“Our study suggests that metformin can be used safely in cirrhotic patients. Diabetic patients who take metformin to control their blood sugar levels can continue taking metformin after cirrhosis diagnosis, if there is no specific contradiction,” said senior author Lewis Roberts, MB, ChB, PhD.

With the potential implications for a major change in current clinical practice, the researchers plan to collaborate with more institutions and to use nationwide databases to further validate the beneficial effects of metformin.

Source: Mayo Clinic; June 18, 2014.

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