Iodinated Contrast Agents and Diabetes

RECOMMENDATION FOR THE USE OF CONTRAST MEDIA

IODINATED CONTRAST AGENTS AND DIABETES

PRESENTATION

There is 3 problems with the diabetic patient: fasting, renal failure, and ongoing medication (insulin, oral antidiabetic, metformin). fasting can cause hypoglycaemic accidents. Renal failure can be worsened by the injection of a contrast agent. Metformin exposes to the risk of lactic acidosis by diminution of renal clea- rance in case of ICM induced nephropathy.

GENERAL ADVICE

Have at hand a recent serum creatinine level test (less than 3 months old in the absence of intercurrent events). Use low osmolality agents. Keep the patient hydrated: orally = 2 litres of sodium rich water in the 24 hours preceding and following contrast medium injection. parenterally: 100ml per hour of saline isotonic serum or bicarbonated isotonic serum in the 12 hours to and after the injection of ICM.

PATIENTS ON INSULIN

Insulin therapy should not be discontinued. Fasting should be avoided. However, in cases where it is recommended, put on a perfusion of glucose until the fast is broken, and do the examination as early as possible. Fasting should not exceed 6 hours.

1 Version 2 - Avril 2005 CIRTACI - RECOMMENDATION FOR THE USE OF CONTRAST MEDIA IODINATED CONTRAST AGENTS AND DIABETES

PATIENTS ON DERIVATIVES OF METFORMIN

Meftformin is the most common of oral antidiabetic drugs. The active princi- ple is not metabolized and is eliminated via the kidneys. Elimination is complete in 48 hours. Metformin is contraindicated in cases of renal insufficiency. Accumulation of the drug can induce lactic acidosis when contrast medium induced renal failure happens (in the 48 hours following the injection). The therapy should be discontinued for 48 hours from the time of iodinated contrast medium administration. Stopping it 48 hours before the examination is not advised anymore. The therapy is resumed once the renal function has been checked.

PATIENTS ON ORAL ANTIDIABETICS (OTHER THAN METFORMIN)

The treatment is continued. In case of renal failure, refer to the specific advice on the prevention of renal failure.

REFERENCES

1. Metformin and contrast media - a dangerous combination? McCartney MM, Gilbert FJ, Murchison LE, Pearson D, McHardy K, Murray AD. Clin Radiol 1999;54:29-33 2. Guidelines for performing angiography in patients taking metformin, Heupler FA. Catheterization and cardiovascular diagnosis 1998;43:121-3 3. Clinical risk associated with contrast angiography in metformin treated patients: a clinical review. Nawaz S, Cleveland T, Gaines PA, Chan P. Clin Radiol 1998;53:342-4 4. Metformin and contrast media: where is the conflict? Rasuli P, Hammond DI. Can Assoc Radiol J 1998;49:161-6 5. Approach to the patient with diabetes undergoing a vascular or interventional procedure. Hirsch IB. J Vasc Interv Radiol. 1997 May-Jun;8(3):329-36. 6. Metformin and contrast media: genuine risk or witch hunt? Pond GD, Smyth SH, Roach DJ, Hunter G. Radiology 1996;201:879-80M

Comité Interdisciplinaire de Recherche et de Société Française de Radiologie Travail sur les Agents de Contraste en Imagerie 2 Version 2 - Avril 2005