Metformin is the first line therapy for patients with diabete type 2. However, the molecule is known to be responsible for lactic acidosis through its inhibition of the mitochondrial respiratory chain complex, a pathology called MALA (metformin associated lactic acidosis). This complication has been widely discussed in the literature because its development is usually the result of a multifactorial and complex process. As the mortality of MALA is potentially high, a good knowledge of the physiopathology, existing treatments and predisposing factors is necessary for the primary care physician.
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