New diabetes algorithm suggests metformin as initial therapy
Metformin, together with lifestyle interventions, should be initial therapy for type 2 diabetes, a treatment algorithm from the European Association for the Study of Diabetes and the American Diabetes Association suggests.
The consensus statement, published in Diabetologia (2006;49:1711), puts
forward two stages of antidiabetic intervention after diagnosis. The
first comprises metformin and lifestyle interventions to decrease weight
and increase activity. If this does not successfully reduce HbA1c levels
below 7 per cent, “additional therapy” should be started.
This comprises insulins, sulfonylureas, thiazolidinediones, alpha-glucosidase
inhibitors, exenatide, glinides and pramlintide, culminating in intensive
insulin therapy with metformin with or without glitazone.
The guidelines and treatment algorithm emphasise “rapid addition
of medications, and transition to new regimens, when target glycaemic
goals are not achieved or sustained” and “early addition
of insulin in patients who do not meet target goals”.
Commenting on the new algorithm, Matt Hunt, science manager at Diabetes
UK, said:“Although the research does say that lifestyle interventions
should be emphasised where possible, overall the paper suggests that
drugs and insulins are ultimately an effective solution.
“While in some cases this may be true we would be concerned that
diet and exercise gets neglected very early on and we would also be worried
about getting people onto medication sooner than they need to.” |
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