Metformin Wins in New Diabetes Guideline

Type 2 diabetes treatment should begin with metformin

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) While personal doctors play a central role in the fight against diabetes, they do not have every remedy at hand. For this reason, they often refer to treatment guidelines for help.

A new guideline from the American College of Physicians recommends that metformin - a tried and true diabetes medication - should be the first drug of choice for type 2 diabetes when changes to diet and lifestyle fail.

"Make sure you get the most up-to-date diabetes treatments."

If patients do not respond to the combination of metformin and lifestyle changes, doctors should add a second medication to reduce patients' blood sugar levels, according to the guideline drawn up by Amir Qaseem, M.D., Ph.D., director of clinical policy at the American College of Physicians, and colleagues.

The American College of Physicians put together this guideline in order to give doctors recommendations on how to successfully treat type 2 diabetes.

Through a review of studies from 1966 through April 2010, Dr. Qaseem and colleagues found that metformin works better than other type 2 diabetes drugs to reduce blood sugar levels. Metformin remains the best choice whether it is used by itself or in combination with other drugs.

"In addition, metformin reduces body weight and improves cholesterol profiles," the American College of Physicians says in a summary of the guideline for patients.

Metformin is a drug that has been used to treat type 2 diabetes for more than half a century. It is sold under brand names such as Fortamet, Glucophage, Glumetza, and Riomet.

Drawing from their findings, the authors lay out three main recommendations.

First, doctors should prescribe an oral drug to type 2 diabetes patients only when diet, exercise, and weight loss fail to get blood sugar under control.

Second, metformin should be the first drug of choice when a doctor decides to start a patient on oral therapy.

Third, doctors should prescribe a second drug on top of metformin if a patient's blood sugar levels are still poorly controlled. "However, no strong evidence supports that one class of drug is better than another as a second drug," the summary for patients reads.

It is important to note these recommendations may not apply to everybody. Some kidney patients, for example, should not take metformin, as they may experience complications.

These clinical guidelines are published in the Annals of Internal Medicine, the journal of the American College of Physicians. 

Reviewed by: 
Review Date: 
February 7, 2012
Last Updated:
February 9, 2012