Document Detail


Initial nonadherence, primary failure and therapeutic success of metformin monotherapy in clinical practice.
MedLine Citation:
PMID:  20658898     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To document the extent to which drug naïve patients with diabetes continued newly initiated metformin monotherapy, and who subsequently experienced primary failure or therapeutic success.
RESEARCH DESIGN AND METHODS: Using an observational longitudinal cohort design, we identified all 3116 type 2 diabetes patients who initiated metformin monotherapy as their first-ever anti-hyperglycemic drug in 2004-2006. We defined initial nonadherence as having occurred in the first 6 months if a patient (1) received only a single metformin dispense, (2) received less than a 90 day supply, or (3) switched to a second anti-hyperglycemic agent. Among those patients who continued metformin monotherapy for at least 6 months, we determined the proportion attaining A1C < 7% by examining A1Cs recorded prior to adding a second anti-hyperglycemic agent or December 31, 2008, whichever occurred first. We identified factors associated with achieving A1C < 7% with logistic regression.
RESULTS: Initial nonadherence occurred in 518 (16.6%) of the 3116 patients studied. Of those who continued metformin for at least 6 months, a majority (71.7% overall) achieved an A1C < 7%, even when pre-metformin A1C was high (59.6% among those with A1C > 9%). Initiating metformin within 3 months of diagnosis increased the probability of success nearly three-fold compared to initiating after 12-23 months (OR 2.85, 95% CI 2.04-3.98). Independent of duration, lower A1C at initiation increased the probability of success.
CONCLUSIONS: Initiating metformin immediately at diagnosis and while A1C is still low substantially increases the probability of attaining glycemic success. Our findings support the current guidelines recommending metformin therapy as soon as type 2 diabetes is diagnosed. This study was limited by its observational design, the inability to assess reasons for metformin nonadherence, and the highly automated study setting.
Authors:
Gregory A Nichols; Christopher Conner; Jonathan B Brown
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Current medical research and opinion     Volume:  26     ISSN:  1473-4877     ISO Abbreviation:  Curr Med Res Opin     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-16     Completed Date:  2010-12-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0351014     Medline TA:  Curr Med Res Opin     Country:  England    
Other Details:
Languages:  eng     Pagination:  2127-35     Citation Subset:  IM    
Affiliation:
Kaiser Permanente Center for Health Research, Portland, Oregon, USA. greg.nichols@kpchr.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Algorithms
Cohort Studies
Databases as Topic
Diabetes Mellitus, Type 2 / drug therapy*,  epidemiology*,  psychology
Female
Humans
Hypoglycemic Agents / adverse effects,  therapeutic use
Longitudinal Studies
Male
Metformin / adverse effects,  therapeutic use*
Middle Aged
Oregon
Patient Compliance / statistics & numerical data*
Professional Practice
Treatment Failure
Treatment Outcome
Washington
Chemical
Reg. No./Substance:
0/Hypoglycemic Agents; 657-24-9/Metformin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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