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