Factors Favoring the Toxic Effects of Metformin in Subjects with Type 2 Diabetes in Two Referral Hospital in Douala, Cameroon

Introduction: The Metformin is a first line agent for the treatment of type 2 diabetes that can be used alone or in combination with sulfonylureas thiazolidinediones, incretin-based drugs, sodium/glucose cotransporter-2 inhibitors, or other hypoglycemic agents. Metformin is the most used anti-hyperglycemic agent for the treatment of Type 2 Diabetes Mellitus. It is considered as a very good drug, with low risk and high benefit. The Metformin liver and pancreatic intoxication can be due to massive ingestion or to a progressive accumulation due to renal failure, hence an elevated blood amylase and transaminases levels. Fatal cases due to metformin intoxication have been described.

Methods: The study was an analytical cross sectional study which was carried out in the Douala General Hospital and the Douala Laquintinie Hospital from the 1st of March 2021 to the 30th of May 2021. Our study population included type 2 diabetic patients above 40years of age who are strictly on oral antidiabetic drugs who came to consult in the Douala General Hospital and the Douala Laquintinie Hospital, the exclusion criteria were; Patients infected with hepatitis A, B or hepatitis C, diabetic patients suffering from other pathologies like fatty liver disease and cirrhosis, liver cancer and others, patients suffering from terminal renal failure, patients who have been on NSAI drugs for long period and also taking alcohol or those with hemolyzed blood. For ethical consideration, after presenting and filling of the consent form, 5ml of blood was collected from each participant for the analyses, serum was conserved at a temperature of -15 to -20oC and the samples were finally analyzed in 2 series on the Biotecnica 1500 chemistry analyzer. Statistical analysis was done on Microsoft Excel 2013 version.

Results: A total of 102 participants were enrolled, female gender was dominant, and the mean age was 69 years. Most of participants felt under neurological clinical effects (tiredness, dizziness, and tingling sensation). We had an average GOT of 28.3, with a minimum of 7.0 and a maximum of 207, an average GPT of 19.8 with a minimum of 5.9 and a maximum of 90.7 and an average amylase was 45.7 with a minimum value of 11.5 and a maximum value of 470. On the other hand, our average GFR was 74.3 with a minimum of 12.8 and a maximum of 153.2. From the study population, 90 where on metformin among which 79 were on stages 2-5 of kidney failure.

Conclusion: This study highlights the risk of liver toxicity for diabetic patient under metformin surfing from renal failure.