The lesson of the week in this weeks journal is an important one.
However, the comment I would make is that in the table it is important to
clearly distinguish between the advice from NICE and the content of the
table related to the personal opinion expressed in the 2003 BMJ editorial.
I think all would support withdrawal of metformin 'during periods of
hypoxia' and certainly in line with royal college of radiology guidance
when having contrast media. However, withdrawal routinely prior to a GA is
much more controversial. This may sometimes be appropriate but often will
not be. It will run the risk of unnecessary instability in diabetes
control which may impact on recovery post op and may result in procedures
being cancelled in some instances.
Rapid Response:
When to Withdraw Metformin
The lesson of the week in this weeks journal is an important one. However, the comment I would make is that in the table it is important to clearly distinguish between the advice from NICE and the content of the table related to the personal opinion expressed in the 2003 BMJ editorial. I think all would support withdrawal of metformin 'during periods of hypoxia' and certainly in line with royal college of radiology guidance when having contrast media. However, withdrawal routinely prior to a GA is much more controversial. This may sometimes be appropriate but often will not be. It will run the risk of unnecessary instability in diabetes control which may impact on recovery post op and may result in procedures being cancelled in some instances.
Competing interests: None declared
Competing interests: