Research Shows Adding A Second Medication May Benefit Patients With Type-2 Diabetes


The American College of Physicians (ACP) suggests in an evidence-based clinical practice protocol, recently published in Annals of Internal Medicine, that doctors should prescribe metformin to people suffering from type 2 diabetes when medication is needed to improve high blood sugar.

Supposing that a second medication is necessary to improve high blood sugar, ACP suggests that doctors think about adding either a sulfonylurea, thiazolidinedione, DPP-4 inhibitor, or SGLT-2 inhibitor to metformin.

The American Academy of Family Physicians has endorsed the protocol. Nitin S. Damle, MD, MS, MACP, ACP president stated, “Metformin, unless contraindicated, is an effective treatment strategy because it has better effectiveness, is associated with fewer adverse effects, and is cheaper than most other oral medications. The escalating rates of obesity in the U.S. are increasing the incidence and prevalence of diabetes substantially. Metformin has the added benefit of being associated with weight loss.”

Because of several new studies evaluating medications for type-2 diabetes, as well as recent FDA approvals of several new medications, ACP updated its 2012 protocol on the comparative effectiveness and safety of oral medications for the treatment of the condition.

Dr. Damle stated, “Adding a second medication to metformin may provide additional benefits. However, the increased cost may not always support the added benefit, particularly for the more expensive, newer medications. ACP recommends that clinicians and patients discuss the benefits, adverse effects, and costs of additional medications.”

Diabetes can disturb other areas of the body and can be the cause of coronary artery, cerebrovascular, retinopathy, peripheral vascular disease complications, and nephropathy. Type-2 diabetes is the most common form of the condition, which affects almost 30 million people in the United States.

ACP’s Guideline Development Process protocol is based on a standardized analysis of randomized controlled trials and observational research on the provisional effectiveness of oral medications for type-2 diabetes. Evaluated interventions include: dipeptidyl peptidase-4 inhibitors, metformin, sulfonylureas, and thiazolidinediones.


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