To the Editor In a recent issue of JAMA Internal Medicine, Lazarus and colleagues1 investigated the relationship between metformin treatment and lactic acidosis across different categories of estimated glomerular filtration rate (eGFR) in 2 large community-based cohorts of patients with diabetes. They did not observe an increased risk of incident hospitalization with lactic acidosis in metformin users with eGFR greater than 30 mL/min/1.73 m2 compared with patients who received alternative diabetes management. However, there was an excess risk of lactic acidosis in metformin users with eGFR less than 30 mL/min/1.73 m2.
Mohammedi K, Blanco L, Rigalleau V. Lactic Acidosis, Metformin Use, and Dose-Response Association. JAMA Intern Med. 2018;178(10):1429. doi:10.1001/jamainternmed.2018.4451
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