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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Metformin has been a cornerstone of type 2 diabetes therapy for decades. It is inexpensive, widely
available, and carries a low risk of hypoglycemia or weight gain. Its affordability, tolerability, and
cardiovascular safety sustain its central role in modern diabetes management. Although generally
well tolerated, its most serious adverse effect is metformin-associated lactic acidosis (MALA)—a rare
but life-threatening condition, with an estimated incidence of 1 per 30,000 patient-years. MALA
typically occurs in the presence of renal or hepatic impairment, sepsis, or dehydration.
To examine trends in MALA over an 11-year period at a large tertiary hospital in Croatia.
Admission records from the Emergency Department of Sestre milosrdnice University Hospital Center
(2014–2024) were reviewed retrospectively for MALA cases. Data on admission date, patients’ age,
comorbidities, therapy, survival status, APACHE II score, and laboratory findings were collected. Time
trends were analyzed using the Mann–Kendall test, and other analyses were performed with
nonparametric tests.
A total of 40 patients with MALA were admitted through the Emergency Department during the
prespecified time period. Of these, 14 (35,0%) were male and 26 (65,0%) were female. The mean age
was 72 years (IQR: 68–80 years).
A significant upward trend was observed (Mann–Kendall test: p = 0.0158, τ = 0.582). MALA incidence
was low before the COVID-19 pandemic but increased sharply afterward, exceeding the expected
rate of 1:30,000 patient-years. Possible contributing factors include disrupted routine care, limited
patient follow-up, and delayed therapy adjustments due to renal dysfunction during the pandemic.
The observed rise in MALA cases during and after the COVID-19 pandemic may reflect the broader
impact of pandemic-related healthcare disruptions. Reduced access to primary and specialist care
likely contributed to delayed recognition of renal impairment and inadequate patient education on
sick-day management, both of which increase MALA risk. The subsequent decline in 2024 suggests
partial recovery of the healthcare system and improved continuity of diabetes care. Similar trends
have been reported in other post-pandemic analyses of chronic disease management. Continuous
patient education, regular renal function monitoring, and timely therapy adjustment remain essential
preventive measures.
MALA incidence increased notably during the pandemic but began to decline in 2024 as the
healthcare system adapted to post-COVID-19 conditions. Sustained vigilance and patient-centered care
are necessary to prevent recurrence of such adverse trends.
