Secondary failure of metformin monotherapy in clinical practice
- PMID: 20040656
- PMCID: PMC2827496
- DOI: 10.2337/dc09-1749
Secondary failure of metformin monotherapy in clinical practice
Abstract
OBJECTIVE We sought to document the secondary failure rate of metformin monotherapy in a clinical practice setting and to explore factors that predict therapeutic failure. RESEARCH DESIGN AND METHODS We studied 1,799 type 2 diabetic patients who, between 2004 and 2006, lowered their A1C to <7% after initiating metformin monotherapy as their first-ever anti-hyperglycemic drug. We examined all A1C values recorded through 31 December 2008 (2-5 years of follow-up), defining secondary failure as a subsequent A1C > or =7.5% or the addition or substitution of another anti-hyperglycemic agent. We used logistic regression to identify factors associated with the probability of secondary failure. RESULTS Of the 1,799 patients studied, 42% (n = 748) experienced secondary failure; the mean failure rate was 17% per year. However, patients who initiated metformin within 3 months of diabetes diagnosis failed at an age-and A1C-adjusted rate of 12.2% (10.5-14.4%) per year, and patients who initiated while A1C was <7% failed at an adjusted rate of 12.3% per year. An interaction term between duration of diagnosed diabetes and A1C was not significant. Age, duration, and A1C at initiation were the only factors that predicted secondary failure. CONCLUSIONS Although metformin failure may occur more rapidly in clinical practice than in clinical trails, initiating it soon after diabetes diagnosis and while A1C is low might preserve beta-cell function, prolong the effectiveness of metformin, reduce lifetime glycemic burden, and prevent diabetes complications. Our findings support the current treatment algorithm for hyperglycemia management that recommends metformin initiation when diabetes is first diagnosed.
Figures


Similar articles
-
Intensification of Diabetes Therapy and Time Until A1C Goal Attainment Among Patients With Newly Diagnosed Type 2 Diabetes Who Fail Metformin Monotherapy Within a Large Integrated Health System.Diabetes Care. 2016 Sep;39(9):1527-34. doi: 10.2337/dc16-0227. Epub 2016 Aug 12. Diabetes Care. 2016. PMID: 27519447
-
Long-term efficacy of sitagliptin as either monotherapy or add-on therapy to metformin: improvement in glycemic control over 2 years in patients with type 2 diabetes.Curr Med Res Opin. 2015 Jun;31(6):1071-7. doi: 10.1185/03007995.2015.1037259. Curr Med Res Opin. 2015. PMID: 25850968 Clinical Trial.
-
Treatment escalation and rise in HbA1c following successful initial metformin therapy.Diabetes Care. 2006 Mar;29(3):504-9. doi: 10.2337/diacare.29.03.06.dc05-1937. Diabetes Care. 2006. PMID: 16505496
-
Repaglinide : a pharmacoeconomic review of its use in type 2 diabetes mellitus.Pharmacoeconomics. 2004;22(6):389-411. doi: 10.2165/00019053-200422060-00005. Pharmacoeconomics. 2004. PMID: 15099124 Review.
-
Drug treatment of type 2 diabetes mellitus in patients for whom metformin is contraindicated.Diabetes Metab Syndr Obes. 2014 Jan 18;7:15-24. doi: 10.2147/DMSO.S38753. eCollection 2014 Jan 18. Diabetes Metab Syndr Obes. 2014. PMID: 24465132 Free PMC article. Review.
Cited by
-
Insulin vs GLP-1 analogues in poorly controlled Type 2 diabetic subjects on oral therapy: a meta-analysis.J Endocrinol Invest. 2013 Mar;36(3):168-73. doi: 10.3275/8367. Epub 2012 Apr 18. J Endocrinol Invest. 2013. PMID: 22522662
-
Efficacy and tolerability of canagliflozin as add-on to metformin in the treatment of type 2 diabetes mellitus: a meta-analysis.Eur J Clin Pharmacol. 2015 Nov;71(11):1325-32. doi: 10.1007/s00228-015-1923-y. Epub 2015 Aug 19. Eur J Clin Pharmacol. 2015. PMID: 26282731
-
Efficacy of DPP-4 inhibitors, GLP-1 analogues, and SGLT2 inhibitors as add-ons to metformin monotherapy in T2DM patients: a model-based meta-analysis.Br J Clin Pharmacol. 2019 Feb;85(2):393-402. doi: 10.1111/bcp.13807. Epub 2018 Dec 6. Br J Clin Pharmacol. 2019. PMID: 30394576 Free PMC article.
-
Real-world treatment escalation from metformin monotherapy in youth-onset Type 2 diabetes mellitus: A retrospective cohort study.Pediatr Diabetes. 2021 Sep;22(6):861-871. doi: 10.1111/pedi.13232. Epub 2021 Jun 30. Pediatr Diabetes. 2021. PMID: 33978986 Free PMC article.
-
Why Do SGLT2 inhibitors inhibit only 30-50% of renal glucose reabsorption in humans?Diabetes. 2012 Sep;61(9):2199-204. doi: 10.2337/db12-0052. Diabetes. 2012. PMID: 22923645 Free PMC article.
References
-
- Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M: Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344:1343–1350 - PubMed
-
- Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V: Indian Diabetes Prevention Programme (IDPP). The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 2006;49:289–297 - PubMed
-
- Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, Zinman B: American Diabetes Association, European Association for Study of Diabetes. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2009;32:193–203 - PMC - PubMed
-
- Nichols GA, Alexander CM, Girman CJ, Kamal-Bahl SJ, Brown JB: Treatment escalation and rise in HbA1c following successful initial metformin therapy. Diabetes Care 2006;29:504–509 - PubMed
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical