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Metformin Provides Sustained Benefit in Type 2 Diabetes

In the UKPDS in the metformin group, significant risk reductions persisted for any diabetes-related end point (21%), myocardial infarction (33%), and death from any cause (27%).

During the United Kingdom Prospective Diabetes Study (UKPDS), patients with type 2 diabetes mellitus who received intensive glucose therapy had a lower risk of microvascular complications than did those receiving conventional dietary therapy.

These UK authors conducted post-trial monitoring to determine whether this improved glucose control persisted and whether such therapy had a long-term effect on macrovascular outcomes. In post-trial monitoring, 3277 patients were asked to attend annual UKPDS clinics for 5 years, but no attempts were made to maintain their previously assigned therapies. Annual questionnaires were used to follow patients who were unable to attend the clinics, and all patients in years 6 to 10 were assessed through questionnaires.

Between-group differences in glycated hemoglobin levels were lost after the first year. In the sulfonylurea-insulin group, relative reductions in risk persisted at 10 years for any diabetes-related end point (9%) and microvascular disease (24%), and risk reductions for myocardial infarction (15%) and death from any cause (13%) emerged over time, as more events occurred. In the metformin group, significant risk reductions persisted for any diabetes-related end point (21%), myocardial infarction (33%), and death from any cause (27%).

Despite an early loss of glycemic differences, a continued reduction in microvascular risk and emergent risk reductions for myocardial infarction and death from any cause were observed during 10 years of post- trial follow-up. A continued benefit after metformin therapy was evident among overweight patients.

Metformin should be first choice for treatment of type 2 diabetes.

N Engl J Med Published at www.nejm.org 10 September 10 2008 © 2008 to the Massachusetts Medical Society: 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes. Rury R. Holman, Sanjoy K. Paul, M. Angelyn Bethel, David R. Matthews, and H. Andrew W. Neil. Correspondence to: Dr. Holman: rury.holman@dtu.ox.ac.uk