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August 14, 2002

Inappropriate Prescription for Metformin

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;288(6):694-695. doi:10.1001/jama.288.6.693

To the Editor: In their Research Letter, Dr Horlen and colleagues1 reported a high frequency of inappropriate metformin prescriptions in patients with type 2 diabetes. However, because of the way in which they ascertained pharmacological treatment, their results grossly overstate the risks to these patients. Horlen et al simply recorded whether patients had a diagnosis of congestive heart failure (CHF) and were also taking a diuretic, an angiotensin-converting enzyme (ACE) inhibitor, or digoxin. Given the high frequency of hypertension in patients with type 2 diabetes (up to 60% in some series) and the relatively high frequency of elevated levels of urinary albumin excretion, it is likely that many of these patients were taking these drugs for the treatment of hypertension or albuminuria. I do not know if the authors confirmed that these drugs were being used for the treatment of CHF and not other causes in these patients, but the fact that only 4 of the 17 had class II or greater CHF makes me doubt this. While I agree that the authors clearly have found a substantial number of patients who should not have been prescribed metformin, the situation may not be as bad as they make it out to be.

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