HealthDay News — Patients newly diagnosed with type 2 diabetes who are initially prescribed metformin are less likely to eventually need other medications to control their blood glucose, according to researchers.

“Although many classes of oral glucose-lowering medications have been approved for use, little comparative effectiveness evidence exists to guide initial selection of therapy for diabetes mellitus,” wrote Niteesh Choudhry, MD, of the Harvard Medical School in Boston, and colleagues in JAMA Internal Medicine.

To determine the effect of initial glucose-lowering agent class on subsequent need for treatment intensification and four short-term adverse clinical events, the investigators conducted a retrospective cohort study. Patients enrolled in the study had started treatment for type 2 diabetes from July 2009 to 2013 (n=15,516). The average follow-up time was slightly longer than one year.

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Of the patients, 57.8% were treated with metformin, and about one-quarter began treatment with a sulfonylurea. Just 6% started with a thiazolidinedione, and 13% with a dipeptidyl peptidase 4 (DPP-4) inhibitor.

In patients prescribed a sulfonylurea, a thiazolidinedione, or a DPP-4 inhibitor added a second drug to their diabetes treatment regimen during the study, reported the inspectors. Just 35% of those on metformin added an additional moral medication during the study period.

Additionally, 5% of those started on metformin later added insulin to their treatment. About 9% of those who started on a sulfonylurea, 6% of those who started on a DPP-4 inhibitor, and 6% of those who started on thiazolidinediones, also took insulin.

“Beginning treatment with metformin was associated with reduced subsequent treatment intensification, without differences in rates of hypoglycemia or other adverse clinical events,” concluded the researchers.

“These findings have significant implications for quality of life and medication costs.”


  1. Choudhry N et al. JAMA Intern Med. 2014; doi: 10.1001/jamainternmed.2014.5294