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New EASD/ADA Consensus Recommends Metformin at Diagnosis of Type 2 Diabetes

COPENHAGEN, DENMARK -- September 13, 2006 -- Newly diagnosed patients with diabetes should be treated with metformin (Glucophage(R)) in conjunction with lifestyle modification (unless metformin is contraindicated). Initiation of metformin should no longer be delayed until lifestyle modification (weight loss and increased activity) fails to adequately control glycaemia.

This is the recommendation of a new consensus statement from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)(1).

Traditionally, guidelines have recommended lifestyle modification as the first step in intervention to reduce glycaemia. Oral antidiabetic treatment should be initiated with metformin, according to guidelines published by the International Diabetes Federation (IDF) in 2005. These guidelines stated that: "Standard care should begin with metformin unless there is evidence or risk of renal impairment."(2)

Now, however, the ADA/EASD expert panel has recognised that lifestyle modification alone often fails to achieve or maintain metabolic goals. Therefore, most patients will also require effective treatment with metformin (Glucophage). Thus, the added benefits of metformin (Glucophage) should not be delayed after diagnosis.

Dr Clifford Bailey, Professor of Clinical Science at Aston University, Birmingham, UK, and a member of the EASD committee that reviewed the new treatment algorithm, said: "Metformin is widely available and efficacious in long-term glycaemic control. The recommendation of metformin at diagnosis of type 2 diabetes is not a major variation from many other treatment algorithms, but is noteworthy in that it appears for the first time in an international consensus guideline."

Metformin (Glucophage) is recommended because it has demonstrated:

- Typical lowering of HbA1c by 1.5-2.0% according to dosage

- Absence of weight gain and hypoglycaemia

- Generally low level of side effects

- High level of acceptance by patients

- Relatively low cost

Additionally, the landmark United Kingdom Prospective Diabetes Study (UKPDS) demonstrated that metformin significantly reduced the risk of fatal and non-fatal cardiovascular events in patients with type 2 diabetes(3). The study showed a 36% reduction in all-cause mortality, a 42% reduction in diabetes-related mortality and a 32% reduction in diabetes-related endpoints.

Following initiation of treatment, the expert group recommends that metformin (Glucophage) should be titrated to the maximum effective and tolerated dose over one to two months. Only after this is achieved should another agent be added if required to achieve glycaemic goals.

REFERENCES:
1. Nathan DM, Buse JB, Davidson MB et al. Management of hyperglycaemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 2006; 49: 1711-1721 and Diabetes Care 2006; 29: 1963-1972.
2. International Diabetes Federation 2005. Clinical Guidelines Task Force. Global guideline for type 2 diabetes. Available from http://www.idf.org.
3. UKPDS Group. Effect of intensive blood glucose control with metformin on complication in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998; 352: 854-65.

- This is the first international treatment algorithm of hyperglycaemia in type 2 diabetes to recommend simultaneous initiation of pharmaceutical therapy and lifestyle intervention in newly diagnosed patients.

- The recommendations were reviewed and approved by the Professional Practice Committee of the American Diabetes Association and by an ad hoc committee of the European Association for the Study of Diabetes (U Smith, Gothenburg, Sweden; S Del Prato, Pisa, Italy; C Bailey, Birmingham, UK; and, B Charbonnel, Nantes, France).


SOURCE: Merck KGaA

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