Metformin dosing for T2D found to be suboptimal

  • Iglay K & al.
  • Endocrinol Diabetes Metab
  • 01/01/2020

  • Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Metformin monotherapy dosing is often suboptimal and uptitration infrequent in patients with type 2 diabetes (T2D), even with above-target HbA1c levels.

Why this matters

  • Hyperglycemia leads to macrovascular and microvascular complications.

Study design

  • Retrospective study of 6174 new metformin users during 2013-2016 and 8733 prevalent users in 2017 from UK Clinical Practice Research Datalink database, comprising 650 primary care practices.
  • Funding: MSD.

Key results

  • Distribution of users initiating metformin, by daily dosing, without varying over time:
    • >0 to ≤500 mg: 25%;
    • >500 to ≤1000 mg: 47%;
    • >1000 to ≤1500 mg: 17%; and
    • >1500 to ≤2000 mg: 12%.
  • Doses of >1000 mg/day were initiated in 48% with HbA1c ≥75 mmol/mol (9.0%) vs 14% with HbA1c
  • Among new users, only 6.7% at 6 months and 10.8% at 12 months had been uptitrated, including only 14.8% with HbA1c ≥75 mmol/mol (9.0%).
  • Predictors of uptitration included younger age at 12 months postinitiation and higher HbA1c at 6 and 12 months.
  • Distribution of prevalent users by daily dose:
    • >0 to ≤500 mg: 14%;
    • >500 to ≤1000 mg: 40%;
    • >1000 to ≤1500 mg: 15%; 
    • >1500 to ≤ 2000 mg: 29%; and 
    • >2000 mg: 1%.

Limitations

  • Potential for database errors.
  • No information on adherence, tolerability.
  • Limited to primary care setting.