[acb-diabetics] early treatment of diabetes..

[Patricia LaFrance-Wolf]

Early Treatment Doubles Chance of Success for People with Diabetes

 

Results from the first study that compares failure rates of Metformin in
real-world setting are out. 

 

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The sooner people with diabetes start taking metformin, the longer the drug
remains effective, according to a Kaiser Permanente study. The study found
that

metformin, helps patients prevent dangerously high blood sugar levels,
worked nearly twice as long for people who began taking it within three
months of

their diabetes diagnosis. This is the first study to compare metformin
failure rates in a real-world, clinical practice setting. Other studies
compared

failure rates of metformin only in clinical trials. 

 

Metformin is recommended as a first-line agent in the treatment of Type 2
diabetes, but in most patients it eventually stops working, forcing them to
take

additional medications to control their blood sugar.  Each additional drug
adds extra costs and the possibility of more side effects including weight
gain,

so this study is welcome news for newly diagnosed patients, researchers
said.  

 

The study's lead author, Jonathan B. Brown, PhD, stated that, "This is an
important finding for the 30 million people world-wide who are diagnosed
with

Type 2 diabetes every year.  The sooner they start taking metformin, the
better and longer it seems to work.... This study suggests that to gain full
benefit

from metformin, patients should start taking it as soon as they find out
they have diabetes."  

 

Researchers used electronic health records to follow nearly 1,800 people
with diabetes in Kaiser Permanente's health plan in Washington and Oregon
for up

to five years. Metformin failed at a rate of only 12 percent a year for the
patients who began taking it within three months of diagnosis. That compares

to a failure rate of 21.4 percent per year for patients who started taking
metformin one to two years after diagnosis, and 21.9 percent per year for
those

who didn't start taking the drug until three years after they were
diagnosed.  

 

"We believe that starting the drug early preserves the body's own ability to
control blood sugar, which in turn prevents the long-term complications of

diabetes like heart disease, kidney failure, and blindness," said study
co-author Gregory A. Nichols, PhD. "The ADA recommends that patients start
taking

metformin and make lifestyle changes as soon as they are diagnosed. This
study provides more evidence to back up that recommendation."   

 

In the study, patients were considered to have failed metformin when their
hemoglobin A1c went above 7.5 percent or when they started taking a second
anti-hyperglycemic

agent. Only patients who initially controlled blood sugar (to less than 7
percent on the A1c test) with metformin were included in the study.  

 

To reduce the possibility that factors other than delay in starting
metformin influenced the results of the study, researchers controlled for
age, gender,

and how well blood sugar was controlled prior to treatment.  After
controlling for these factors, an even stronger relationship emerged between
the time

a patient started on the drug, and the amount of time it remained effective.
Still, the authors caution that other unmeasured factors could have
influenced

the results. 

 

Secondary Failure of Metformin Monotherapy in Clinical Practice

 

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