Metformin Therapy Is Effective in Nonobese Patients With Type 2 Diabetes

There is now evidence-based data to support metformin use in nonobese individuals with type 2 diabetes.” Metformin therapy was effective in a cohort of nonobese patients with type 2 diabetes, according to the results of a study reported in the November issue of Diabetes Care.

"The U.K. Prospective Diabetes Study (UKPDS) has demonstrated that metformin is as effective as sulfonylureas in obese subjects and is associated with less weight gain, fewer hypoglycemic episodes, and better cardiovascular outcomes," write Cynthia R. Ong, MD, from the Royal Prince Alfred Hospital in Sydney, New South Wales, Australia, and colleagues. "It is hence the pharmacological therapy of choice in this subgroup. However, a gap in our present knowledge is the long-term response to metformin in nonobese individuals."

Using a database of patients treated at a referral center in Sydney, the investigators identified 644 patients with type 2 diabetes and complete hemoglobin A1C (HbA1c) data who were treated with metformin or sulfonylurea monotherapy for at least 3 visits before receiving dual oral therapy. These individuals were categorized as normal, overweight, or obese (body mass index [BMI], < 25, 25 – 29.9, and = 30 kg/m2, respectively), and data were analyzed by BMI and the type of oral agent.

There were no differences between the initial, follow-up, and last HbA1c data among the 3 metformin-treated groups. In the normal and overweight groups, the duration of successful glycemic control with metformin monotherapy and the incidences of diabetes-related complications for the entire duration of follow-up were not inferior to those in the obese group. The nonobese patients had better outcomes regardless of the type of oral hypoglycemic agent used.

"We conclude that metformin is at least as efficacious in normal and overweight individuals as it is in those who are obese," the authors write. "Our study provides evidence-based data to support metformin use in nonobese individuals with type 2 diabetes."
Study limitations include observational and retrospective design, subjects not matched, metformin group younger with a slightly earlier presentation to the Diabetes Centre, and data on complications not rigorously defined.

"It is unlikely that another study like the UKPDS would ever be performed, although the ADOPT (A Diabetes Outcome Progression Trial) study may soon provide valuable information," the authors conclude. "In the meantime, our data provide some insight and reassurance in the use of metformin in diabetic patients who are not obese."

Diabetes Care. 2006;29:2361-2364.

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