Development of Metformin Associated Lactic Acidosis (MALA) Prevention Model for Diabetes Mellitus type 2 Patient in Na dun Hospital

Abstract

This research is an action research study aimed at development of metformin associated lactic acidosis (MALA) prevention model for diabetes mellitus type 2 diabetes patients at Na dun Hospital. A purposive sample of 170 participants was selected, including 20 multidisciplinary healthcare professionals (physicians, nurses, pharmacists, pharmaceutical officers, and computer scientists) and 150type 2 diabetes patients using metformin. The study was conducted from October 2021 to September 2023. The research instruments included: 1) guidelines for MALA prevention at Na dun Hospital, 2) patient data recording forms, and 3) satisfaction questionnaires. Qualitative data were analyzed using content analysis, and quantitative data were analyzed using descriptive statistics.

Research Findings:

 1.Analysis of MALA Issues: The study revealed a lack of clear prevention models for MALA. There was insufficient review and monitoring of drug use, and patients with a history of MALA continued to receive metformin. There were no established guidelines for preventing MALA.

2.Development of the MALA Prevention Model: The developed model included the following component. 1) Creating prescribing guidelines for metformin based on eGFR levels. 2) Defining roles for multidisciplinary teams in monitoring and preventing MALA. 3) Establishing monitoring protocols for patients with a history of MALA. 4) Developing informational resources for prescribing metformin. 5) Creating multidisciplinary team guidelines for patient care. 6) Producing educational materials on adverse drug reactions related to metformin use.

3. The evaluation results showed that the model was developed through three iterative cycles, resulting in the creation of the "MALA Na Dun Model." Implementation of this model led to dose reductions in 16.67% of patients, discontinuation of the medication in 4.67% of patients, and appropriate dose adjustments in 3.33% of patients. No incidents of MALA were reported. Furthermore, the multidisciplinary team expressed a high level of satisfaction with the model development (= 4.18, SD = 0.46).  .