Research progress of iodine contrast agent examination in patients with type 2 diabetes mellitus taking metformin

doi:10.3760/cma.j.issn.1007-1245.2023.24.003

Abstract

Abstract:

At present, metformin and iodine contrast agent are widely used in clinic. Due to the risk of acute renal injury induced by contrast medium, patients with type 2 diabetes mellitus (T2DM) are often prohibited or postponed the examination and treatment by iodine contrast agent, resulting in misdiagnosis or delay of treatment and indirect damage to patients. Therefore, how to safely and standardizedly use iodine contrast medium in patients with T2DM has been the focus of clinical attention. By analyzing the clinical research and related guidelines of metformin and iodine contrast agent, this paper discusses the safety of metformin and iodine contrast agent, in order to provide references for clinicians.

Key words:

Type 2 diabetes mellitus, Metformin, Iodine contrast agent, Lactic acidosis, Progress

摘要：

二甲双胍与碘造影剂近年来广泛应用于临床，由于二者同时使用存在造影剂诱导的急性肾损伤的风险，2型糖尿病（T2DM）患者往往被禁止或推迟使用碘造影剂的检查和治疗，导致误诊或延误治疗，对患者造成了间接伤害。因此，碘造影剂在T2DM患者中如何安全、规范使用一直是临床上关注的重点。本文通过分析整理二甲双胍和碘造影剂合用的临床研究和相关指南共识，探讨二者联合使用的安全性，以期为临床医生提供参考。

关键词:

2型糖尿病, 二甲双胍, 碘造影剂, 乳酸酸中毒, 进展

Qi Yanzhi, Wu Yanping.

Research progress of iodine contrast agent examination in patients with type 2 diabetes mellitus taking metformin [J]. International Medicine and Health Guidance News, 2023, 29(24): 3537-3541.

戚燕芝吴艳萍.

服用二甲双胍的2型糖尿病患者进行碘造影剂检查的研究进展 [J]. 国际医药卫生导报, 2023, 29(24): 3537-3541.

References

[1] Inzucchi SE, Bergenstal RM, Buse JB,et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American diabetes association and the european association for the study of diabetes[J]. Diabetes Care,2015,38(1):140-149.DOI: 10.2337/dc14-2441.
[2] 二甲双胍临床应用专家共识(2018年版)[J]. 中国糖尿病杂志,2019,27(3):161-173. DOI:10.3969/j.issn.1006-6187. 2019.03.001.
[3] Cosentino F, Grant PJ, Aboyans V,et al. 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD[J]. Eur Heart J,2020,41(2):255-323.DOI: 10.1093/eurheartj/ehz486.
[4] Inzucchi SE, Lipska KJ, Mayo H,et al. Metformin in patients with type 2 diabetes and kidney disease: a systematic review[J]. JAMA,2014,312(24):2668-2675.DOI: 10.1001/jama.2014.15298.
[5] Richy FF, Sabidó-Espin M, Guedes S,et al. Incidence of lactic acidosis in patients with type 2 diabetes with and without renal impairment treated with metformin: a retrospective cohort study[J]. Diabetes Care,2014,37(8):2291-2295.DOI: 10.2337/dc14-0464.
[6] Salpeter SR, Greyber E, Pasternak GA,et al. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus[J]. Cochrane Database Syst Rev,2010,2010(4):CD002967.DOI: 10.1002/14651858.CD002967.
[7] Weinstein JR, Anderson S. The aging kidney: physiological changes[J]. Adv Chronic Kidney Dis,2010,17(4):302-307.DOI: 10.1053/j.ackd.2010.05.002.
[8] Nijssen EC, Rennenberg RJ, Nelemans PJ,et al. Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial[J]. Lancet,2017,389(10076):1312-1322. DOI: 10.1016/S0140-6736(17)30057-0.
[9] Wong GT, Irwin MG. Contrast-induced nephropathy[J]. Br J Anaesth,2007,99(4):474-483.DOI: 10.1093/bja/aem237.
[10] 张巧权,谢俐萍,肖潇,等. 不同浓度碘对比剂对造影患者肾功能的影响[J]. 当代护士(中旬刊),2015(5):145-146.
[11] 李嵘. 等渗与低渗造影剂对慢性肾功能不全患者肾毒性的对比研究[J]. 黑龙江中医药,2022,51(2):340-342.
[12] Namazi MH, AlipourParsa S, Roohigilani K,et al. Is it necessary to discontinue metformin in diabetic patients with GFR > 60 ml/min per 1.73 m2 undergoing coronary angiography: a controversy still exists?[J]. Acta Biomed,2018,89(2):227-232.DOI: 10.23750/abm.v89i2.5446.
[13] Oktay V, Calpar Çıralı İ, Sinan ÜY,et al. Impact of continuation of metformin prior to elective coronary angiography on acute contrast nephropathy in patients with normal or mildly impaired renal functions[J]. Anatol J Cardiol,2017,18(5):334-339. DOI: 10.14744/AnatolJCardiol.2017.7836.
[14] Posma RA, Lexis CP, Lipsic E,et al. Effect of metformin on renal function after primary percutaneous coronary intervention in patients without diabetes presenting with ST-elevation myocardial infarction: data from the GIPS-III trial[J]. Cardiovasc Drugs Ther,2015,29(5):451-459.DOI: 10.1007/s10557-015-6618-1.
[15] Gómez Herrero H, De Arriba Villamor C, Buldain Parra M,et al. Nefrotoxicidad por contrastes yodados en estudios de tomografía computarizada a pacientes ambulatoriso diabéticos en tratamiento con metformina [Nephrotoxicity due to iodine contrasts in computerized tomography studies of diabetic outpatients on metformin][J]. An Sist Sanit Navar,2013,36(2):197-201. Spanish.DOI: 10.4321/s1137-66272013000200003.
[16] 于琪,朱佳佳,刘文娴. 二甲双胍对行直接经皮冠状动脉介入治疗患者造影剂肾病发病率的影响[J]. 中国医药,2020,15(4):490-494. DOI:10.3760/j.issn.1673-4777. 2020.04.003.
[17] Zeller M, Labalette-Bart M, Juliard JM,et al. Metformin and contrast-induced acute kidney injury in diabetic patients treated with primary percutaneous coronary intervention for ST segment elevation myocardial infarction: amulticenter study[J]. Int J Cardiol,2016,220:137-142.DOI: 10.1016/j.ijcard.2016.06.076.
[18] 盛青江. 不同剂量二甲双胍对急性心肌梗死合并2型糖尿病患者PCI术后造影剂肾病发病率的影响[J]. 数理医药学杂志,2022,35(4):548-550. DOI:10.3969/j.issn.1004- 4337. 2022.04.025.
[19] 陈晓扬,张曦元,姚姗姗,等. 不同剂量二甲双胍对行直接经皮冠状动脉介入治疗患者造影剂肾病发病率的影响[J]. 实用医学杂志,2020,36(20):2834-2837. DOI:10.3969/j.issn.1006-5725.2020.20.018.
[20] 张玲娣,任国飞,陈青莲. 造影期间继续使用二甲双胍对患者肾功能的影响及其相关因素分析[J]. 中国药师,2019,22(2):270-272. DOI:10.3969/j.issn.1008- 049X. 2019.02.018.
[21] Chiarito M, Sanz-Sanchez J, Piccolo R,et al. Safety of metformin continuation in diabetic patients undergoing invasive coronary angiography: the NO-STOP single arm trial[J]. Cardiovasc Diabetol,2023,22(1):28.DOI: 10.1186/s12933-023-01744-4.
[22] Kim SK, Jung J, Jung JH,et al. The association between use of metformin and change in serum CO2 level after administration of contrast medium[J]. Clin Radiol,2016,71(6):532-536.DOI: 10.1016/j.crad.2016.02.007.
[23] Lal A, Kaur N, Trivedi N. Metformin, arterial contrast and acute kidney Injury[J]. Acta Biomed,2019,90(2):355-356.DOI: 10.23750/abm.v90i2.8371.
[24] Jung J, Cho YY, Jung JH,et al. Are patients with mild to moderate renal impairment on metformin or other oral anti-hyperglycaemic agents at increased risk of contrast-induced nephropathy and metabolic acidosis after radiocontrast exposure?[J].Clin Radiol,2019,74(8):651.e1-651.e6.DOI: 10.1016/j.crad.2019.05.011.
[25] 李耀静,王静,高燕燕. 二甲双胍对2型糖尿病患者造影剂肾病的影响[J]. 青岛大学医学院学报,2011,47(5):434-435,438.
[26] Yu Q, Zhu JJ, Liu WX. Effect of continuous use of metformin on kidney function in diabetes patients with acute myocardial infarction undergoing primary percutaneous coronary intervention[J]. BMC Cardiovasc Disord,2020,20(1):187.DOI: 10.1186/s12872-020- 01474-5.
[27] 李耀静,王静,李莉,等. 水化治疗及二甲双胍对2型糖尿病患者造影剂肾病的影响[J]. 山东大学学报(医学版),2011,49(8):5-8,12.
[28] Goergen SK, Rumbold G, Compton G,et al. Systematic review of current guidelines, and their evidence base, on risk of lactic acidosis after administration of contrast medium for patients receiving metformin[J]. Radiology,2010,254(1):261-269.DOI: 10.1148/radiol.09090690.
[29] Thomsen HS, Morcos SK. Contrast media and metformin: guidelines to diminish the risk of lactic acidosis in non-insulin-dependent diabetics after administration of contrast media. ESUR contrast media safety committee[J]. Eur Radiol,1999,9(4):738-740.DOI: 10.1007/s003300050746.
[30] Contrast Media Safety Committee ER. Guidelines on Contrast Media v9. CMSC, 2014[EB/OL].http://www.esur-cm.org/index.php/en/. 15 December 2017.
[31] American Collgeg of Radiology.ACR.Manual on contrast media [EB/OL].https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast Media.pdf.
[32] Morcos SK, Thomsen HS, Webb JA. Contrast-media-induced nephrotoxicity: a consensus report. Contrast media safety committee, european society of urogenital radiology (ESUR)[J]. Eur Radiol,1999,9(8):1602-1613.DOI: 10.1007/s003300050894.
[33] van der Molen AJ, Reimer P, Dekkers IA,et al. Post-contrast acute kidney injury - Part 1: definition, clinical features, incidence, role of contrast medium and risk factors : recommendations for updated ESUR contrast medium safety committee guidelines[J]. Eur Radiol,2018,28(7):2845-2855.DOI: 10.1007/s00330- 017-5246-5.
[34] European Society of Urogenital Radiology.ESUR guidelines on contrast agents 10.0[EB/OL].http:/ /www.Esur.org/ fileadmin/content/2019/ESUR Guidelines 10.0 Final Version.pdf.
[35] 中华医学会糖尿病学分会微血管并发症学组. 中国糖尿病肾脏疾病防治临床指南[J]. 中华糖尿病杂志,2019,11(1):15-28. DOI:10.3760/cma.j.issn.1674-5809.2019.01.004.
[36] 中华医学会神经病学分会,中华医学会神经病学分会神经血管介入协作组. 脑血管造影术操作规范中国专家共识[J]. 中华神经科杂志,2018,51(1):7-13. DOI:10.3760/cma.j.issn.1006-7876.2018.01.003.
[37] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华内分泌代谢杂志,2021,37(4):311-398. DOI:10.3760/cma.j.cn311282-20210304- 00142.
[38] 薛国强,卫欣欣,姚娜,等. 二甲双胍通过调控PARP-1活性对Ⅱ型糖尿病肾脏的保护作用[J]. 昆明医科大学学报,2021,42(6):29-37. DOI:10.12259/j.issn.2095-610X.S20210632.
[39] De Broe ME, Kajbaf F, Lalau JD. Renoprotective effects of metformin[J]. Nephron,2018,138(4):261-274.DOI: 10.1159/000481951.
[40] Sardu C, Paolisso P, Sacra C,et al. Effects of metformin therapy on coronary endothelial dysfunction in patients with prediabetes with stable angina and nonobstructive coronary artery stenosis: the CODYCE multicenter prospective study[J]. Diabetes Care,2019,42(10):1946-1955.DOI: 10.2337/dc18-2356.