ACP: Metformin Should Be First Choice In Type 2 Diabetes Oral Therapy

Clinicians should prescribe monotherapy with metformin for initial oral therapy to treat patients with type 2 diabetes who do not respond to lifestyle and diet changes, says a new guideline from the American College of Physicians (ACP).

"We found that most diabetes medications reduced blood sugar levels to a similar degree," said Amir Qaseem, MD, PhD, director of clinical policy at the ACP. "However, metformin is more effective compared to other type 2 diabetes drugs in reducing blood sugar levels when used alone and in combination with other drugs."

The guideline also recommends that a second agent be added if metformin monotherapy fails to control hyperglycemia, although there is insufficient data to recommend which secondary agent be used. 

The guideline is built upon data from an evaluation of literature published on the effectiveness and safety of type 2 diabetes medications from 1966 to 2010. Its 3 recommendations –Beginning oral pharmacologic therapy when lifestyle changes fail, employing metformin as the first oral therapy, and adding a second agent if metformin fails to control hyperglycemia- were all graded "strong recommendation" with "high-quality evidence" on the ACP clinical practice guidelines grading system.  

-Michael Potts