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Metformin Ranks Highest As Diabetes Treatment

Literature analysis finds metformin superior to DPP-4 inhibitors for lowering HbA1c

TUESDAY, March 15 (HealthDay News) -- Metformin may be the best choice for a first-line agent to treat patients with type 2 diabetes, according to research published online March 14 in the Annals of Internal Medicine.

Wendy L. Bennett, M.D., M.P.H., of the Johns Hopkins University School of Medicine in Baltimore, and colleagues reviewed 140 randomized controlled trials and 26 observational studies to summarize the harms and benefits of various medications in the treatment of type 2 diabetes in adults.

The researchers found metformin superior to dipeptidyl peptidase-4 (DPP-4) inhibitors for lowering HbA1c, though most medications did so by 1 percentage point. Combination regimens resulted in a similar reduction. There was a four-fold higher risk of mild to moderate hypoglycemia associated with sulfonylureas compared to metformin alone; the risk increased to five-fold when sulfonylureas were combined with metformin compared with a metformin plus thiazolidinediones combination. In addition, metformin decreased low-density lipoprotein cholesterol relative to pioglitazone, sulfonylureas, and DPP-4 inhibitors, though diarrhea occurred more often in metformin users than in thiazolidinedione users.

"Comprehensive information comparing benefits and harms of diabetes medications can facilitate personalized treatment choices for patients. Although the long-term benefits and harms of diabetes medications remain unclear, the evidence supports use of metformin as a first-line agent. Comparisons of two-drug combinations showed little to no difference in HbA1c reduction, but some combinations increased risk for hypoglycemia and other adverse events," the authors write.

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