Second-line Drugs and Associated Outcomes in Diabetes Patients on Metformin

A new retrospective chart review of electronic medical record data analyzed what drugs are added to metformin for type 2 diabetes (T2D) patients on dual anti-diabetic medication, and how treatment intensification impacts glycated hemoglobin (HbA1c) and body mass index (BMI) outcomes six and 12 months following treatment initiation. The study included data from the primary care practice in Fairview Health System in Minnesota between July 1, 2012, and Aug. 31, 2017. Final analysis included 3,413 T2D patients aged ≥18 years receiving dual anti-diabetic medication with metformin as first-line treatment. The most common add-on therapies second to metformin were sulfonylurea (51%, n = 1,724/3,413) and basal insulin (37%, n = 1,268/3,413). A total of 2,134 patients had baseline and follow-up HbA1c data; mean six-month HbA1c reductions were: glucagon-like peptide (GLP-1) agonist (−1.3, P<0.001), sulfonylurea (−1.1, P<0.001), basal insulin (−1.1, P<0.001), and dipeptidyl peptidase 4 (DPP4) inhibitor (−0.7, P=0.223). Mean 12-month HbA1c reductions were: GLP-1 agonist (−1.2, P<0.001), sulfonylurea (−0.9, P<0.001), basal insulin (−1.0, P<0.001), and DPP4 inhibitor (−0.8, P=0.049). The GLP-1 agonist group had a higher mean baseline BMI (40.3 kg/m2) and was also the only group whose BMI significantly decreased between baseline and six (–1.5 kg/m2, P=0.049) and 12 months (–1.8 kg/m2, P=0.041).