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Metformin Is Best Initial Oral Drug for Lowering Glucose Levels in Diabetes Patients

Metformin, sulfonylureas, thiazolidinedione, and DPP-4 inhibitors were compared to evaluate the effects on the time to subsequent treatment…

There are many classes of oral drugs used for diabetes therapy, but there is a lack of evidence as to which drug is best for use as initial therapy. Most patients diagnosed with diabetes are prescribed metformin to lower their glucose levels. This study compared four different classes of drugs to see the effect of initial oral glucose lowering and need for subsequent treatment.

This was a retrospective cohort study of patients, fully insured members of Aetna, who were prescribed an oral drug from July 1, 2009 to June 30, 2013. Patients who needed a second add-on drug within 90 days of the end of day’s supply of the first prescription were studied, a total of 15,516 patients. These patients were divided into four groups given different treatments as an initial therapy. Out of 15,516 participants, 8,964 patients were started on metformin, 3,570 patients were started on sulfonylurea, 948 patients were started on thiazolidinedione, and 2,034 patients were started on DPP-4 inhibitors.

From the data results, patients who were prescribed metformin as an initial therapy were less likely to require add on therapy. While 24.5% patients on metformin required an add-on oral medication, 37.1% of patients on sulfonylurea, 39.6% of patients on thiazolidinedione, and 36.2% patients on DPP-4 inhibitor required an add-on oral medication. Moreover, 5.1% of patients on metformin later added insulin, compared to 9.1% of patients on sulfonylureas, 6.2% of patients on thiazolidinedione, and 5.6% of patients on DPP-4 inhibitor and added insulin later on.

The researchers concluded, “Despite guidelines, only 57.8% of individuals began diabetes treatment with metformin. Beginning treatment with metformin was associated with reduced subsequent treatment intensification, without differences in rates of hypoglycemia or other adverse clinical events. These findings have significant implications for quality of life and medication costs.”

Practice Pearls:

  • In this study, researchers compared four different drug classes as an initial treatment for diabetes and the need for subsequent add on treatment.
  • Researchers compared metformin, sulfonylureas, thiazolidinedione, and DPP-4 inhibitors as an initial treatment.
  • Initial treatment of metformin showed reduced requirement of subsequent medication compared to other classes.

Berkowitz, Seth. “Initial Choice of Oral Glucose-Lowering Medication for Diabetes Mellitus A Patient-Centered Comparative Effectiveness Study.” JAMA Intern Med. Published online October 27, 2014. doi:10.1001/jamainternmed.2014.5294