American College of Physicians Revises Diabetes Treatment Strategies


Metformin is recommended as the first-line therapy for patients with type 2 diabetes.

The American College of Physicians (ACP) recently changed recommendations that advise healthcare professionals how to care for patients with type 2 diabetes.

The ACP is now recommending that physicians prescribe metformin to these patients, according to the new guidelines published in the Annals of Internal Medicine. These guidelines compare the safety and efficacy of type 2 diabetes drugs to inform prescribing and disease management decisions.

If treatment alone with metformin does not result in blood glucose control, it is recommended that physicians add sulfonyleurea, thiazolidinedione, a SGLT-2 inhibitor, or a DPP-4 inhibitor to their current drug regimen.

“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,” said ACP President Nitin S. Damle, MD, MS, MACP. “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.”

These new guidelines received endorsement by the American Academy of Family Physicians, the ACP reported.

The recommendations, previously published in 2012, were updated to include findings from multiple new studies assessing different treatment options, and also to evaluate drugs newly-approved by the FDA.

ACP guidelines are created through a systematic review of clinical trials that compare the efficacy of oral treatments for the disease, according to the study. The researchers evaluated metformin, thiazolidinediones, sulfonylureas, and dipeptidyl peptidase-4 inhibitors.

The investigators discovered that all drugs were able to control specific factors, such as blood glucose levels, weight, blood pressure, heart rate, mortality, retinopathy, nephropathy, neuropathy, and harm.

As part of the review process, the ACP also identifies gaps that need to be explored further through additional research, according to the study. By doing so, the ACP hopes to advance diabetes research in a way that will provide additional treatment options for patients whose disease may not be controlled by current medications.

Other studies have found that metformin may be underused as a first-line therapy for patients with type 2 diabetes. With these new recommendations, it is likely that physicians will see the benefit of metformin for their patients.

These new guidelines are put into place with the goal of informing physicians and patients how to adequately control diabetes, especially among those who would benefit from a combination therapy.

“Adding a second medication to metformin may provide additional benefits,” Dr Damle concluded. “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.”

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