Novel Assay of Metformin Levels in Patients With Type 2 Diabetes and Varying Levels of Renal Function Clinical recommendations

OBJECTIVE - To study trough levels of metformin in serum and its intra-individual variation in patients using a newly developed assay. RESEARCH DESIGN AND METHODS - Trough serum levels of metformin were measured once using liquid chromatography tandem mass spectrometry (LCMSMS) in 137 type 2 diabetic patients with varying renal function (99 men) and followed repeatedly during 2 months in 20 patients (16 men) with estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2) body surface. RESULTS - Patients with eGFR >60, 30-60, and <30 ml/min/1.73 m(2) had median trough metformin concentrations of 4.5 mu mol/l (range 0.1-20.7, n = 107), 7.71 mu mol/l (0.12-15.15, n = 21), and 8.88 mu mol/l (5.99-18.60, n=9), respectively. The median intra-individual overall coefficient of variation was 29.4% (range 9.8-74.2). CONCLUSIONS - Determination of serum metformin with the LCMSMS technique is useful in patients on metformin treatment. Few patients had values >20 mu mol/l. Metformin measurement is less suitable for close titration.