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Dual therapy superior in low-income patients with type 2 diabetes

Dual therapy outperformed metformin monotherapy or transitioning therapies and may be preferred for low-income individuals with newly diagnosed type 2 diabetes, according to research recently published in the Journal of Primary Care and Community Health.

“Diabetes control in low-income settings is a difficult task and is often overwhelming. Due to significant barriers to care, choosing optimal initial therapy has critical implications in these settings,” Elizabeth M. Vaughan, DO, MPH, assistant professor in the department of medicine at Baylor College of Medicine, told Healio Family Medicine. “There are variable recommendations regarding initiating monotherapy or dual therapy in diabetes. Clear initial strategies are of particular importance in underserved settings where access to care and financial burdens are significant barriers.”

Researchers conducted a retrospective chart review of 309 low-income adults initiated on oral hypoglycemic agents who received their health care in the Houston area. Participants also had newly diagnosed type 2 diabetes with a confirmatory provider note.

After 12 months, patients prescribed dual therapy (n = 74) had a greater HbA1c change vs. those (n = 159) assigned monotherapy with metformin (1.11%; P < .01), Vaughan and colleagues found. Patients who transitioned therapies (n = 55) did not significantly differ in HbA1c levels vs. monotherapy during the same period, and 21 patients discontinued oral hypoglycemic agents during the study. The mean decrease in HbA1c score for the entire sample at 12 months was 2.36%.

“Our findings suggest that patients initiated on dual therapy consisting of metformin and a sulfonylurea may have better HbA1c outcomes. ... The rationale for this is not clear, though some literature has suggested synergism between the two drugs/classes we studied (metformin and sulfonylureas),” Vaughan said in the interview. “Future studies are warranted to establish oral agent dosing protocols to clarify additive effects between sulfonylureas and metformin.” – by Janel Miller

Disclosure: The authors report no relevant financial disclosures.