ReviewDiabetes, obesity & metabolism2017
Metformin-associated lactic acidosis (MALA): Moving towards a new paradigm.
Review in Diabetes, obesity & metabolism, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 63 papers, 6 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
63 citing papers in PubMed, 6 syntheses or guidelines pooled it, 130 citations in OpenAlex.
- [Hospital diabetes management (Update 2026)].Wiener klinische Wochenschrift · 2026Guideline
- Systematic review and meta-analysis of current guidelines, and their evidence base, on risk of renal function after administration of contrast medium for diabetic patients receiving metformin.Frontiers in medicine · 2025Pooled it
- Metformin's Role in Hyperlactatemia and Lactic Acidosis in ICU Patients: A Systematic Review.Pharmacology · 2023Pooled it
- Continuous use of metformin in patients receiving contrast medium: what is the evidence? A systematic review and meta-analysis.European radiology · 2022Pooled it
- Metformin in Patients With COVID-19: A Systematic Review and Meta-Analysis.Frontiers in medicine · 2021Pooled it
- The Association between Metformin Therapy and Lactic Acidosis.Drug safety · 2019Pooled it
- Endogenous Biomarkers to Evaluate Transporter-Mediated Drug-Drug Interactions: Current Evidence, Impact on Clinical Pharmacology Strategy, Remaining Gaps, and Future Directions.Journal of clinical pharmacology · 2026Review
- Metformin-associated lactic acidosis during flood-related healthcare disruption in southern Thailand, 2025: a case series.Tropical medicine and health · 2026Article
- Atypical Presentation of Metformin-associated Lactic Acidosis: A Case Report.Clinical practice and cases in emergency medicine · 2026Article
- Fatal metformin-associated lactic acidosis in a healthy woman after massive overdose.JCEM case reports · 2026Article
- Metformin promotes mitochondrial integrity through AMPK-signaling in Leber's hereditary optic neuropathy.FEBS open bio · 2026Article
- Article
- Metformin Beyond Glycemic Control: Cardiovascular Protection and Diabetes Prevention.Journal of cardiovascular development and disease · 2026Review
- Metformin-Induced Lactic Acidosis Following Intentional Overdose: A Case Report and Mini Review.Cureus · 2025Article
- Regional citrate anticoagulation ensures safe and effective kidney replacement therapy in metformin-associated lactic acidosis.Clinical kidney journal · 2025Article
- Efficacy of continuous venovenous hemodiafiltration in patients with metformin associated lactic acidosis and acute kidney injury.Scientific reports · 2025Article
- Past use of metformin is associated with increased risk of myelodysplastic syndrome development in diabetes mellitus patients: a cross-sectional study of 54,869 patients.BMC pharmacology & toxicology · 2025Article
- Comprehensive GC-MS Measurement of Amino Acids, Metabolites, and Malondialdehyde in Metformin-Associated Lactic Acidosis at Admission and during Renal Replacement Treatment.Journal of clinical medicine · 2024Article
- Delaying Renal Aging: Metformin Holds Promise as a Potential Treatment.Aging and disease · 2024Review
- Clinical outcomes following discontinuation of metformin in patients with type 2 diabetes and advanced chronic kidney disease in Hong Kong: a territory-wide, retrospective cohort and target trial emulation study.EClinicalMedicine · 2024Article
3 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
6 authors at 5 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Although metformin has been used for over 60 years, the balance between the drug's beneficial and adverse effects is still subject to debate. Following an analysis of how cases of so-called "metformin-associated lactic acidosis" (MALA) are reported in the literature, the present article reviews the pitfalls to be avoided when assessing the purported association between metformin and lactic acidosis. By starting from pathophysiological considerations, we propose a new paradigm for lactic acidosis in metformin-treated patients. Metformin therapy does not necessarily induce metformin accumulation, just as metformin accumulation does not necessarily induce hyperlactatemia, and hyperlactatemia does not necessarily induce lactic acidosis. In contrast to the conventional view, MALA probably accounts for a smaller proportion of cases than either metformin-unrelated lactic acidosis or metformin-induced lactic acidosis. Lastly, this review highlights the need for substantial improvements in the reporting of cases of lactic acidosis in metformin-treated patients. Accordingly, we propose a check-list as a guide to clinical practice.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.