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Evidence supports metformin as first-line treatment for diabetes

A systematic evidence review and meta-analysis supports current guidelines recommending metformin as first-line therapy for type 2 diabetes. The review is published in Annals of Internal Medicine.

Type 2 diabetes is a significant public health problem and most patients with the disease eventually require glucose-lowering medications to reduce their risk of long-term complications. More than seven classes of diabetes medications are recommended as first- or second-line therapy. As evidence on the newer versus older diabetes medications continues to amass, clinicians and patients need updated evidence on their comparative effectiveness and safety to make informed treatment choices.

Researchers reviewed published studies to compare the effectiveness and safety of monotherapy (thiazolidinediones, metformin, sulfonylureas, DPP-4 inhibitors, and GLP-1 receptor antagonists) and selected metformin-based combinations in adults with type 2 diabetes. The evidence showed that metformin monotherapy was associated with a lower risk for cardiovascular mortality compared with sulfonylurea monotherapy and also had favorable effects on blood glucose and body weight. Given its benefits and relative safety profile, the evidence supports metformin as a first-line therapy for diabetes.

Article: Diabetes Medications as Monotherapy or Metformin-Based Combination Therapy for Type 2 Diabetes: A Systematic Review and Meta-analysis, Nisa M. Maruthur, MD, MHS; Eva Tseng, MD, MPH; Susan Hutfless, PhD; Lisa M. Wilson, ScM; Catalina Suarez-Cuervo, MD; Zackary Berger, MD, PhD; Yue Chu, MSPH; Emmanuel Iyoha, MBChB, MPH; Jodi B. Segal, MD, MPH; and Shari Bolen, MD, MPH, Annals of Internal Medicine, doi:10.7326/M15-2650 , published online 19 April 2016.