Against guidelines, many with T2D discontinue metformin

  • Khunti K & al.
  • BMJ Open
  • 30 ago. 2020

  • de Miriam Tucker
  • Clinical Essentials
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Takeaway

  • About 15% of patients with type 2 diabetes (T2D) in a large study discontinued metformin when starting a second-line medication.

Why this matters

  • The practice contradicts international guidelines and potentially leaves patients at increased risk for hyperglycemia and associated adverse outcomes.

Study design

  • 3-year, prospective, observational study with data from 14,668 patients with T2D from 38 countries across 6 continents seen in a variety of clinical settings, of whom 80.7% had received metformin as first-line treatment (alone or in combination).
  • Funding: AstraZeneca.

Key results

  • Of 11,837 who received first-line metformin, 84.9% continued it when receiving a second glucose-lowering medication, while 15.1% discontinued it.
  • Proportions discontinuing metformin ranged from 6.9% in Africa to 20.6% in South-East Asia (16.6% in Europe).
  • Among 1782 who discontinued metformin, the most common second-line therapies were dipeptidyl peptidase-4 inhibitor (27.0%) and sulphonylurea (20.3%) monotherapies.
  • Lack of efficacy was the reason stated for changing therapy among 86.04% of patients overall, for 88.79% (8928/10,055) who continued metformin, and 70.53% (1257/1782) who discontinued metformin.
  • Metformin discontinuation was more common among patients with chronic kidney disease and aged ≥75 years.

Limitations

  • Quality of care varies across countries.
  • Missing data for some study variables.