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Dtsch Med Wochenschr 2021; 146(02): 121-127
DOI: 10.1055/a-1241-2407
Übersicht

Metformin-Therapie bei operativen Eingriffen und Gabe jodhaltiger Kontrastmittel

Metformin Therapy During Surgical Interventions and Iodinated Contrast Agent Use
Sebastian Masur
,
Albrecht Eisert
,
Mathias Freitag
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Das perioperative und das periinterventionelle Management von Metformin bei Verwendung von Kontrastmitteln zu Diagnosezwecken wird in Literatur und Praxis uneinheitlich definiert bzw. gehandhabt. Der Beitrag stellt die verschiedenen Leitlinien und den aktuellen wissenschaftlichen Stand vor.

Abstract

Metformin as first-line treatment in type 2 diabetes mellitus (T2 D) shows benefits in terms of reducing cardiovascular events, but the risk of a lactic acidosis as a serious adverse event especially in patients with decreased renal function is still relevant. Since the perioperative management of Metformin or its use in diagnostic procedures with contrast agents is inconsistent in literature and different in practice, the results of various guidelines are reviewed below showing the current state of evidence. Despite many guidelines, the evidence on both issues is low, as they are mainly based on consensus recommendations. The guidelines are still based on weak data and many international recommendations have clearly different statements. A fundamental problem with drugs is that expert information does specify eGFR limits for dose reduction, but not the method to be used. Depending on the formula, this can then lead to different treatment decisions. At present, it is not possible to give reliable recommendations for practice with the aim of minimising the interruption of therapy. For this reason, only a strictly conservative approach with 48-hour breaks before and after both measures can be recommended at present. For the situations mentioned in this overview, the question of the right approach has not yet been conclusively and definitely answered, therefore further studies should be carried out.

Schlüsselwörter

Metformin - Niereninsuffizienz - perioperatives Management - Kontrastmittel - Typ-2-Diabetes-mellitus

Key words

metformin - renal dysfunction - perioperative management - contrast agent - type 2 diabetes mellitus


Publication History

Article published online:
19 January 2021

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