Issue: March 2012
February 06, 2012
1 min read

ACP recommends metformin as first medication to treat type 2 diabetes

Qaseem A. Ann Intern Med. 2012;156:218-231.

Issue: March 2012
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The American College of Physicians recommends that metformin be the first medication used to treat type 2 diabetes when diet, exercise and weight loss do not improve blood sugar, according to a new clinical practice guideline.

“We found that most diabetes medications reduced blood sugar levels to a similar degree,” Amir Qaseem, MD, PhD, FACP, MHA, director of clinical policy at the American College of Physicians (ACP), said in a press release. “However, metformin is more effective compared to other type 2 diabetes drugs in reducing blood sugar levels when used alone and in combination with other drugs. In addition, metformin reduces body weight and improves cholesterol profiles.”

ACP also recommends that clinicians add a second medication to metformin when hyperglycemia persists, despite lifestyle modifications and metformin monotherapy. However, they do not recommend a specific class of drugs for the second medication because of insufficient evidence.

The guideline is based on a systematic evidence review that included literature published from 1966 to April 2010. The researchers searched the Medline, Embase and Central databases for English-language publications. The outcomes evaluated for this review included all-cause mortality, cardiovascular morbidity and mortality, cerebrovascular morbidity, neuropathy, nephropathy and retinopathy.

“The evidence shows that most diabetes medications reduced HbA1c levels to a similar degree,” the guideline authors wrote. “Metformin was more effective than other medications as monotherapy with another agent for reducing HbA1c levels, body weight and plasma lipid levels.”

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