Metformin-associated lactic acidosis (MALA): moving towards a new paradigm?

The history of Metformin-Associated Lactic Acidosis( MALA) is rooted in the earlier experience with phenformin, another biguanidetreatment for type 2 diabetes that was removed from the market owing to a clear causal association with cases of lactic acidosis(LA). Although metforminis less problematic in this regard, metformincan and does induce lactic acidosis, and under the right circumstances it continues to present a potential risk to patients. Recent liberalization of the prescribing guidelines in the US and EU specifically regarding use in more advanced stages of Chronic Kidney Disease (CKD) have led to renewed interest in the topic of MALA, and this issue of the Journal presents two timely articles on the topic by Lalau et al. [1] and Connelly et al. [2].