First-line treatment with metformin for diabetes is associated with significantly less intensification of treatment, and fewer short-term adverse outcomes such as cardiovascular events, emergency department visits, and hypoglycemia, compared with other oral glucose-lowering medications.
A retrospective cohort study of 15,516 patients prescribed an oral glucose-lowering medication found that 25% of patients initially prescribed metformin required a second oral agent, compared with 37% of patients prescribed a sulfonylurea, 40% of those prescribed a thiazolidinedione, and 36% of those prescribed a dipeptidyl peptidase–4 inhibitor, according to a retrospective study published online Oct. 27 (JAMA Intern. Med. 2014 Oct. 27 [doi: 10.1001/jamainternmed.2014.5294]).
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Only 25% of patients initially prescribed metformin required a second oral agent.
While numerous guidelines recommend metformin as the first-line choice of glucose-lowering agents, only 58% of patients started therapy with metformin, with a sulfonylurea the second-most-popular choice, despite its increased risk of adverse cardiovascular events.
“Because underuse of metformin may lead to important harms and costs in the treatment of patients with diabetes, multilevel interventions to increase prescribing quality may be needed,” wrote Dr. Seth A. Berkowitz of Harvard University, Boston, and his colleagues.
The study was supported by an unrestricted grant from CVS Health to Brigham and Women’s Hospital, Boston. One author declared funding from an Institutional National Research Service Award, the Ryoichi Sasakawa Fellowship Fund, and Massachusetts General Hospital. There were no other conflicts of interest declared.