Metformin

A new study carried out in the US has found that rapid treatment intensification could significantly help improve HbA1c levels after the failure of metformin therapy.

Carried out at Cleveland Clinic, researchers examined participants with type 2 diabetes who were struggling to reach or maintain blood glucose level targets while undertaking metformin monotherapy (taking metformin as their sole diabetes medication).

5,239 patients were identified to have not reached their HbA1c targets between 2005 and 2013, after a minimum of three months of metformin treatment. They were then analyzed based on the length of time between achieving their goal and how early their therapy was intensified. Intensification of therapy refers to using other diabetes drugs to produce a stronger effect towards lowering blood glucose levels.

The researchers categorized people into three groups:

  • Those not meeting an HbA1c goal of 7%
  • Those not meeting a goal of 7.5%
  • Those not meeting a goal of 8%

Of these people, across all three categories, those patients who had an earlier intensification of therapy tended to meet their goals faster.

Study author Kevin M. Pantalone told Endocrine Today: “The results of our study demonstrate that a substantial number of patients with newly diagnosed type 2 diabetes fail to undergo intensification of therapy within six months of metformin monotherapy failure, a concerning finding given that the study also found that an early intervention (within six months) in patients who fail metformin monotherapy resulted in a more rapid attainment of HbA1c goals.”

He added: “After patients are initiated on a regimen of metformin and lifestyle modification, we should be checking the HbA1c within three months and intensifying therapy in those who are still not at goal (generally an HbA1c < 7%).” “What remains to be seen is if these early and aggressive interventions actually translate into improvements in clinical outcomes, not just an HbA1c goal attainment. This will be the topic of future research.” The study was published online the Diabetes Care journal.