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Metformin Monotherapy Not Always Best Start in Type 2 Diabetes
Metformin failure in people with type 2 diabetes is very common, particularly among those with high A1c levels at the time of diagnosis, new findings suggest.
An analysis of electronic health record data for more than 22,000 patients starting metformin at three US clinical sites found that over 40% experienced metformin failure.
This was defined as either failure to achieve or maintain A1c less than 7% within 18 months or the use of additional glucose-lowering medications.
Other predictors that metformin use wouldn’t be successful included increasing age, male sex, and race/ethnicity. However, the latter ceased to be linked after adjustment for other clinical risk factors.
“Our study results suggest increased monitoring with potentially earlier treatment intensification to achieve glycemic control may be appropriate in patients with clinical parameters described in this paper,” Suzette J. Bielinski, PhD, and colleagues say.
“Further, these results call into question the ubiquitous use of metformin as the first-line therapy and suggest a more individualized approach may be needed to optimize therapy,” they add in their article published online in the Journal of Clinical Endocrinology and Metabolism.
J Clin Endocrinol Metab. Published online January 7, 2023. Abstract
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