ACP recommends metformin to treat type 2 diabetes based on CE analysis of oral medications

February 6, 2012 in Diabetes

The American College of Physicians (ACP) recommends that clinicians add metformin as the initial drug treatment for most patients with type 2 diabetes when lifestyle modifications such as diet, exercise, and weight loss have failed to adequately improve high blood sugar.

ACP also recommends that clinicians add a second drug to metformin when treatment with metformin and lifestyle changes fail to control blood sugar levels. Citing insufficient evidence, ACP does not recommend one class of drug over another as a second medication.

The recommendations are part of a new ACP published today in , ACP's flagship journal. ACP developed the guideline based on an analysis of the comparative effectiveness and safety of different classes of oral diabetes drugs approved by the US Food and Drug Administration for the treatment of high blood sugar in people with type 2 diabetes: metformin, sulfonylureas, meglitinides, thiazolidinediones, DPP-4 inhibitors, and GLP-1 .

ACP evaluated the evidence of the impact of high blood sugar levels on clinical outcomes such as body weight, cholesterol and , all-cause mortality, cardiovascular disease and death, neuropathy, and kidney function.

"We found that most diabetes medications reduced blood sugar levels to a similar degree," said Amir Qaseem, MD, FACP, PhD, MHA, Director of Clinical Policy at ACP. "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."

For side effects, the risk for dangerously low was higher with sulfonylureas than with other type 2 . Metformin was associated with fewer side effects than sulfonylureas.

The evidence was insufficient to show any difference in effectiveness between various medications across subgroups of adults, such as age, sex, or race.

Best Practice Advice

The guideline includes a Best Practice Advice section to help clinicians practice high value, cost-conscious care. ACP recommends prescribing generic metformin because it has better effectiveness than the majority of the other medications; is associated with fewer adverse effects, including that it does not result in weight gain; and is less expensive.

Patient Education

The guideline notes that good management of type 2 diabetes includes patient education. A patient summary of the guideline is available at http://www.annals.org/content/156/3/I-36.full.

Provided by American College of Physicians

not rated yet  

Rank not rated yet
Relevant PhysicsForums posts
  • The idea behind a reverse shock
    created6 hours ago
  • Guass's Law for a charge distribution
    created6 hours ago
  • Noise dependence
    created7 hours ago
  • siphon and bernouli theorum
    created8 hours ago
  • Hot gas expansion rate into outer space
    created8 hours ago
  • Magnetic field lines through copper
    created13 hours ago
  • More from Physics Forums - Classical Physics

More news stories

Youth with type 2 diabetes at much higher risk for heart, kidney disease

The news about youth and diabetes keeps getting worse. The latest data from the national TODAY diabetes study shows that children who develop Type 2 diabetes are at high risk to develop heart, kidney and eye problems faster ...

Diabetes created May 24, 2013 | popularity not rated yet | comments 0

Type 2 diabetes progresses faster in kids, study finds

(HealthDay)—Type 2 diabetes is more aggressive in children than adults, with signs of serious complications seen just a few years after diagnosis, new research finds.

Diabetes created May 23, 2013 | popularity not rated yet | comments 0

Statin use is linked to increased risk of developing diabetes, warn researchers

Treatment with high potency statins (especially atorvastatin and simvastatin) may increase the risk of developing diabetes, suggests a paper published today in BMJ.

Diabetes created May 23, 2013 | popularity not rated yet | comments 0

Diabetes' genetic underpinnings can vary based on ethnic background, studies say

Ethnic background plays a surprisingly large role in how diabetes develops on a cellular level, according to two new studies led by researchers at the Stanford University School of Medicine.

Diabetes created May 23, 2013 | popularity not rated yet | comments 0 | with audio podcast

Fish oil supplements may help fight against Type 2 diabetes

Widely-used fish oil supplements modestly increase amounts of a hormone that is associated with lower risk of diabetes and heart disease, according to a study accepted for publication in The Endocrine Society's Journal of ...

Diabetes created May 22, 2013 | popularity 5 / 5 (2) | comments 1


First drug to improve heart failure mortality in over a decade

Coenzyme Q10 decreases all cause mortality by half, according to the results of a multicentre randomised double blind trial presented today at Heart Failure 2013 congress. It is the first drug to improve heart failure mortality ...

Seniors more likely to crash when driving with pet, study finds

(HealthDay)—Animals make great companions for senior citizens, but elderly people who always drive with a pet in the car are far more likely to crash than those who never drive with a pet, researchers have ...

Heart failure accelerates male 'menopause'

Heart failure accelerates the aging process and brings on early andropausal syndrome (AS), according to research presented today at the Heart Failure Congress 2013. AS, also referred to as male 'menopause', was four times ...

Death highest in heart failure patients admitted in January, on Friday, and overnight

Mortality and length of stay are highest in heart failure patients admitted in January, on Friday, and overnight, according to research presented today at the Heart Failure Congress 2013. The analysis of nearly 1 million ...

Feds fight morning-after pill age ruling in NY

(AP)—Department of Justice lawyers have again asked a federal appeals court in New York to delay lifting age restrictions and prescription requirements on an emergency contraceptive popularly known as the morning-after ...

New immune system discovered

(Medical Xpress)—A research team, led by Jeremy Barr, a biology post-doctoral fellow, unveils a new immune system that protects humans and animals from infection.