Slide New to diabetes, try metformin first…
New to Diabetes, try metformin first...
New to diabetes, try metformin first…
Diabetes is a disease that is widely prevalent and present in upto 6-12 % of Americans. While easy to diagnose, impaired glucose tolerance in those with fasting sugars above 100 or HgA1cs> 5.7, and diabetes in those with > 126 fasting glucose or HgA1c> 6.5, the treatment is less clear. There is wide variation in what to use as the first agent. Metformin though recommended by the ADA American Diabetic Association as the first line treatment is not the agent used in upto 40% of newly diagnosed diabetes cases. Sulfonylureas (glyburide, glipizide, etc), thiazolidinediones (pioglitazone), dipeptidyl peptidase 4 inhibitors (sitagliptin, etc) were commonly used in many and the confusion partly arises from recommendations by the American Association of Clinical Endocrinologists treatment algorithms.
A recent study ‘Initial Choice of Oral Glucose – Lowering Medication of DM: A Patient-Centered Comparative Effectiveness Study' published in the journal JAMA 2014, studied specifically just that in 15,000 patients treated for diabetes, and came to conclusions that when agents other than metformin were used as first line, there was a high incidence of treatment escalation requiring either metformin, or other agents including insulin to be added when compared to starting metformin alone (over 60% increased incidence). Metformin is cautiously used or avoided in renally insufficient patients or those with heart failure. Otherwise Metformin is cheap, effective and well tolerated. In addition weight loss is a welcome side effect of Metformin.
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Discuss treatment options with your physician and endocrinologist.