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By CAFMI AI From Journal of General Internal Medicine
**Understanding Resident Practices:** The discontinuation of metformin upon hospital admission is a prevalent practice among resident physicians despite evolving clinical guidelines suggesting that many patients can safely continue therapy. This common clinical behavior reflects a complex interplay of caution, institutional protocol, and educational gaps. Residents frequently cite concerns about potential adverse effects such as lactic acidosis and renal impairment as influencing their decision to stop metformin. However, these fears often persist despite updated guidelines that support the continuation of metformin in many hospitalized patients, especially those without severe renal dysfunction or other contraindications. The study delves into these resident-driven decision-making processes through interviews and surveys, highlighting the disconnect between current evidence-based recommendations and day-to-day clinical practice in inpatient settings.
**Bridging the Evidence-Practice Gap:** The findings of this analysis underscore an essential clinical implication: while metformin is generally regarded as safe for continued use in a broad range of hospitalized patients, uncertainty and confusion among trainees contribute to its frequent discontinuation. This conservative approach, although well-intentioned to mitigate risk, may inadvertently expose patients to less optimal glucose management and potential complications from abrupt therapy changes. Institutional protocols that recommend or default to stopping metformin compound this issue, as residents often adhere rigidly to these processes despite the nuanced clinical context of each patient. There is a clear need for clearer, evidence-aligned institutional guidelines and targeted educational initiatives that enhance resident knowledge about the safe management of metformin during acute illness and hospital stays. Such efforts could improve clinical outcomes by promoting consistency and confidence in therapeutic decisions, reducing unwarranted interruptions to established diabetes management.
**Optimizing Metformin Management in Hospitalized Patients:** To address this contested standard of care, the study advocates for systematic revisions in hospital policies and resident education. Developing and implementing institutional protocols that incorporate the latest clinical evidence could standardize decision-making regarding metformin continuation or discontinuation tailored to individual patient risk profiles. Educational curricula for internal medicine residents should emphasize the updated understanding of metformin’s safety, particularly its low risk of lactic acidosis in most hospitalized patients without acute contraindications. Additionally, integrating decision-support tools and pathways into hospital electronic medical records may guide clinicians at the point of admission to evaluate metformin use appropriately. Clinicians are encouraged to assess renal function carefully, monitor for evolving clinical conditions, and counsel patients on medication changes to promote continuity of care. Future research should explore interventions to align resident practices with guidelines, evaluate patient outcomes related to metformin management in acute settings, and test educational models aimed at bridging knowledge gaps. These steps promise to harmonize metformin use in hospitals, improving the management of diabetes and patient safety.
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