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ADA recommends metformin to treat type 2 diabetes

Annals of Internal Medicine today published a synopsis focusing on the updated 2017 American Diabetes Association Standards of Medical Care in Diabetes sections regarding pharmacologic approaches for patients with type 2 diabetes, which recommends metformin as the first-line pharmacologic treatment for the disease.

“These practice guidelines provide an extensive set of evidence-based recommendations that are updated annually for the diagnosis and management of patients with diabetes,” James J. Chamberlain, MD, St. Mark’s Hospital and St. Mark’s Diabetes Center in Salt Lake City, and colleagues wrote. “The [ADA Professional Practice Committee] revised recommendations based on the new evidence or, in some cases, to clarify prior ones or match the strength of the wording to the strength of the evidence.”

For their 2017 Standards, the ADA Professional Practice Committee, composed of endocrinologists and other diabetes experts, updated evidence-based recommendations for the diagnosis and management of patients with diabetes. The ADA committee used MEDLINE searches performed from Jan. 1 2016 to November 2016 to reflect on the most recent additions, clarifications and revisions made to diabetes care recommendations, rating them based on the strength of clinical results.

Metformin, which received the highest rating by the committee, is recommended as the initial pharmacologic therapy for managing type 2 diabetes. The evidence suggests that metformin is an effective and inexpensive option that may decrease the risk for cardiovascular events and death in patients with diabetes. The research shows that for patients with HbA1c level of 9% or higher who are not acutely symptomatic, doctors should consider initiating dual combination therapy to more rapidly reach the target HbA1c level. After roughly 3 months of therapy, providers should examine whether the patient has achieved the HbA1c target.

Alternatively, combination therapy that includes insulin should be considered if the patient has a random glucose level of 16.7 mmol/L or higher or an HbA1c level of 10% or higher and has acute symptoms of polyuria, polydipsia or weight loss. When and if insulin therapy, commonly used with metformin and sometimes one additional non-insulin agent, becomes necessary, the recommended approach is to prescribe patients 10 units of basal insulin per day and increase the dose by 10% to 15% once or twice weekly until their levels met the fasting blood glucose target. Concentrated insulin products, inhaled insulin and combination injectable therapy can be considered if the target HbA1c level is still not met. Using a patient-based approach, physicians should refer to the ADA’s recommendation chart to help decide the right regimen for each individual patient. – by Savannah Demko

Disclosure: Chamberlain reports personal fees from Merck, Janssen Pharmaceuticals and Sanofi. Please see the full study for a complete list of all other authors’ relevant financial disclosures.