Patients with diabetes who begin lowering their glucose levels with metformin are less likely to require subsequent treatment intensification.
However, research published in the Journal of the American Medical Association Internal Medicine shows that 40 per cent of patients do not start off with metformin.
When compared with other oral medicines, metformin was associated with a reduced need for a second treatment without differences in hypoglycaemia rates.
Glucose lowering study
Niteesh K. Choudhry, MD, PhD, Executive Director, Centre for Healthcare Delivery Sciences, Brigham and Women’s Hospital, Harvard Medical School and his colleagues studied patients with diabetes between July 2009 and June 2013.
They analysed the initial choice of a medication to lower glucose levels and whether the subsequent treatment intensification was in the same class of dosage.
Of those 15,516 patients, 8,964 patients (57.8 per cent) began diabetes treatment with metformin. This led to the lowest percentage, 24.5 per cent, of patients who required a second oral medication.
Meanwhile, the percentage of patients who later used insulin was 5.1, having begun treatment with metformin, which increased to 9.1 per cent for patients who started with sulfonylurea.
Metformin guidelines
Metformin is widely advocated as the initial treatment to lower glucose levels in patients with type 2 diabetes, but research suggests these guidelines are not being stuck to with vigilance.
“Despite guidelines, only 57.8 percent of individuals began diabetes treatment with metformin,” the researchers concluded.
“Beginning treatment with metformin was associated with reduced subsequent treatment intensificatio, without differences in rates of hypoglycemia or other adverse clinical events. These findings have significant implications for quality of life and medication costs”.

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