Lactic acidosis rates in type 2 diabetes.

OBJECTIVE: To provide a context for the interpretation of lactic acidosis risk among patients using metformin, we measured rates of lactic acidosis in patients with type 2 diabetes before metformin was approved for use in the U.S. RESEARCH DESIGN AND METHODS: Using electronic databases of hospital discharge diagnoses and laboratory results maintained by a large, nonprofit health maintenance organization (HMO). we identified possible lactic acidosis events in three geographically and racially diverse populations with type 2 diabetes. We then reviewed hard-copy clinical records to confirm and describe each event and determine its likely cause(s). RESULTS: From >41.000 person-years of experience, we found four confirmed, three possible, and three borderline cases of lactic acidosis. In each case, we identified at least one severe medical condition that could have caused the acidosis. The annual confirmed event rate is similar to published rates of metformin-associated lactic acidosis. CONCLUSIONS: Lactic acidosis occurs regularly, although infrequently, among persons with type 2 diabetes, at rates similar to its occurrence among metformin users. The medical conditions with which both metformin-associated and naturally occurring lactic acidosis co-occur are also its potential causes. The observed association between metformin and lactic acidosis may be coincidental rather than causal. This possibility merits further study

Using erythromycin. Some helpful observations.

Erythromycin is a very safe antibiotic that is effective against a wide variety of common and uncommon bacterial infections. Several formulations are available, each with a different absorption rate and dosing profile. The most common side effect of erythromycin is gastrointestinal intolerance, which appears to be related to disruption of intestinal motility. Gastrointestinal tolerance may be improved by limiting daily doses to less than 4 g; temporarily decreasing the total daily dose; using small doses of liquid suspension every 2, 3, or 4 hours; taking the medication with milk or food; and drinking water every 15 minutes two or three times after each dose. These measures may, in turn, improve compliance and efficacy in affected patients.