The use of metformin, a generic oral treatment for diabetes, may help recently diagnosed diabetics not only control their blood sugar levels, but also reduce the need to be prescribed additional medication to manage the disease, according to new research conducted by CVS Health. In addition to being low-cost, the study was able to demonstrate the efficacy of the treatment in providing positive outcomes in patients’ quality of life at a point when there is little evidence of comparison between initial oral diabetes medications.
Researchers used the information from medical and prescription insurance claims, and concluded that individuals treated with sulfonylurea (SFU), dipeptidyl peptidase-4 (DPP-4) inhibitor, and thiazolidinedione (TZD) were significantly more likely to need to also undergo an oral agent, a second oral agent, or insulin, compared to individuals treated with metformin.
The collaborative investigation between the CVS Health Research Institute and Brigham and Women’s Hospital, whose results were recently published in the JAMA Internal Medicine journal, analyzed data from more than 15,000 patients who were being treated with an oral glucose-lowering drug between July 2009 and June 2013. The findings are believed to provide insight on the efficiency of the management of newly diagnosed diabetes.
“It is essential to identify the simplest therapy for patients to assure they stay on their medication,” said the chief scientific officer of CVS Health, William Shrank, M.D. “Research indicates that when patients and providers need to intensify treatment with a second drug or insulin to achieve the desired health outcome, it can reduce patient quality of life in the same way that complications related to the disease can.”
The study also confirms previous clinical evidence about metformin as a first line diabetes treatment, after another study conducted at Brigham and Women’s Hospital demonstrated the drug’s efficacy in decreasing the need for follow-up intensification treatments. Despite the positive results, the researchers noted that more information supporting the benefits of the medication is needed.
Among the group of patients studied, 58% started on metformin, while the other 42% underwent a variety of other treatments, influencing not only their patient outcomes, but also the health care costs. CVS Caremark had already conducted a different study in 2012 in which the researchers demonstrated that in 35 percent of newly diagnosed diabetes cases, the physicians did not follow the treatment guidelines for medications — another possible cause for alterations in both the quality and costs of care.
“With more than 25 million Americans affected and annual costs totaling more than $174 billion, diabetes remains a national public health priority,” explained one of the authors of the study, Niteesh Choudhry, M.D., PhD, who is an associate physician in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital, and an associate professor at the Harvard Medical School. “By focusing our research on treatment intensification, which can be very difficult for patients and is inherently associated with increased side effects and costs, this study provides useful information to help patients and their doctors select an initial therapy.”
Baylor College of Medicine (BCM) recently engaged in a patient recruitment initiative for the study “Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study” (GRADE), which is funded by the National Institutes of Health (NIH) and aims to study the safety and efficacy of taking metformin with one of four medications approved by the U.S. Food and Drug Administration for the treatment of type 2 diabetes.