Metformin-associated lactic acidosis (MALA), a rare but potentially fatal complication associated with the diabetes medication metformin, has prompted urgent attention in clinical settings. Recent findings indicate that a structured intervention protocol can significantly reduce mortality rates related to this condition. The results of this study will be presented at the ASN Kidney Week 2025, scheduled from November 5–9, 2025.
Researchers implemented a rigorous protocol at Maharat Nakhon Ratchasima Hospital (MNRH) in Thailand, focused on the early diagnosis and treatment of MALA. This intervention included the immediate initiation of dialysis, utilizing methods such as intermittent hemodialysis, continuous kidney replacement therapy, or peritoneal dialysis. In contrast, Burirum Hospital (BH) did not adopt this protocol for comparison.
Over a five-year period, the study encompassed a total of 347 cases. At MNRH, the number of cases included 70 before the intervention and 129 during the intervention. At BH, there were 148 cases throughout the same timeframe. Notably, the 30-day mortality rate at MNRH dropped from 25.7% prior to the intervention to 13.9% afterward. In contrast, BH saw no significant change, with mortality rates of 27.2% and 30% during the same periods.
The data also revealed a consistent decline in mortality rates at MNRH, with a decrease of -2.08% per quarter during the intervention. Additionally, the average door-to-dialysis time—defined as the interval from a patient’s hospital admission to the start of dialysis—was significantly reduced from 870 minutes to 690 minutes. Awareness of MALA among healthcare professionals at MNRH notably increased from 38.5% to 89.9% following the implementation of the protocol.
Dr. Watanyu Parapiboon, the corresponding author of the study from MNRH, emphasized the importance of the findings. “A standardized MALA protocol covering diagnosis, access, and treatment shortened door-to-dialysis time, increased awareness, and reduced care variation,” he stated. “Fast-track dialysis pathways should be adopted for time-sensitive conditions like MALA. Availability of all dialysis modalities ensures flexibility and enables timely treatment initiation.”
These results suggest that the adoption of structured protocols in the management of MALA can lead to significant improvements in patient outcomes. Hospitals worldwide may benefit from implementing similar practices to enhance care for patients experiencing this serious complication of diabetes treatment.
