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ACP Guidelines Say Metformin Is the Best Starter Drug for Type 2s

The latest clinical guidelines for treating type 2 diabetes from the American College of Physicians (ACP) indicate that when diet, exercise, and weight loss fail to control blood sugar levels in early type 2 patients, physicians should prescribe metformin as the first drug therapy.

The ACP recommends that metformin be prescribed initially as a stand-alone monotherapy. As the disease progresses and metformin’s initial efficacy begins to fade, doctors can add a second drug.

To develop its recommendations, the ACP examined 44 years of data on the performance of all FDA-approved oral medications for type 2s, from 1966 through early 2010. The drug types reviewed included metformin, sulfonylureas, meglitinides, thiazolidinediones, DPP-4 inhibitors, and GLP-1 receptor antagonists.

The ACP discovered that while most of the drugs have similar effects in reducing blood sugar levels, metformin is the most effective in doing so, whether used alone or in combination. The ACP also found that metformin helps reduce body weight and improve cholesterol counts.

The study reinforces what has become a common practice among healthcare professionals who deal with type 2 diabetes. Metformin, first developed in the 1970s, has become the preferred first medication prescribed for patients with early-stage type 2. It has also become a common therapy for prediabetes patients and people with metabolic syndrome who are attempting to stave off type 2 diabetes.

The ACP noted that there was insufficient evidence to discern any difference in the efficacy of type 2 drugs among adults based on age, sex, or ethnicity.


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