New guidelines issued by American College of Physicians has said the diabetes drug metformin should be the first drug of choice in oral therapy treatment of patients with type 2 diabetes who have failed to respond to changes in diet and lifestyle. Metformin monotherapy was recommended as the first oral agent as it appears to be more effective than the alternatives, despite most treatments being seen to lower HbA1c by about the same amount.
The guidelines, published in the Annals of Internal Medicine, argued that a second agent can also be added if the patient’s hyperglycemia is not being properly controlled by metformin, although there is currently not enough evidence to support a recommendation of a particular secondary agent over another.
The report focused on identifying the most effective treatment strategy for these agents by carrying out a comparative safety and effectiveness analysis of previous studies. The main guideline claims that patients should be put on oral therapy when diet, exercise and weight loss have not managed to control their hyperglycaemia .
Amir Qaseem, director of clinical policy at the American College of Physicians, commented “We found that most diabetes medications reduced blood sugar levels to a similar degree.”
He added “However, metformin is more effective compared to other type 2 diabetes drugs in reducing blood sugar levels when used alone and in combination with other drugs.”

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