Monotherapy in patients with type 2 diabetes mellitus

Abstract

In order to improve the quality of life and to prevent chronic complications related to diabetes mellitus, intensive lifestyle modification and proper medication are needed from the early stage of diagnosis of type 2 diabetes mellitus (T2DM). When using the first medication for diabetic patients, the appropriate treatment should be selected considering the clinical characteristics of the patient, efficacy of the drug, side effects, and cost. In general, the use of metformin as the first treatment for oral hypoglycemic monotherapy is recommended because of its excellent blood glucose-lowering effect, relatively low side effects, long-term proven safety, low risk of hypoglycemia, and low weight gain. If metformin is difficult to use as a first-line treatment, other appropriate medications should be selected in view of the clinical situation. If the goal of achieving glycemic control is not achieved by monotherapy, a combination therapy with different mechanisms of action should be initiated promptly.

Iraqi Experts Consensus on the Management of Type 2 Diabetes/Prediabetes in Adults

“…Metformin is the medication of choice in monotherapy because of its high efficacy (up to 2% HbA1c reduction), low risk of hypoglycemia, and low cardiac toxicity. 39 However, a glomerular filtration rate (GFR) < 30 mL/min is a contraindication for metformin. 40 The ADA, 41 “American association of clinical endocrinologists/American college of endocrinologist (AACE/ACE)” 42 and IDF guidelines 10 established metformin as the medication of choice at all stages of diabetes management.…”

Second-line glucose-lowering drugs added to metformin and the risk of hospitalization for heart failure: A nationwide cohort study

“…In Korea, MET is the most commonly prescribed drug in Korea [5]. MET can be prescribed as a first-line glucose-lowering treatment for T2D under health insurance coverage when the patient’s glycated hemoglobin is <53 mmol/mol (7.0%).…”

“…Metformin (MET) is the most commonly used starting drug for patients with T2D on the basis of international guidelines [3]. In Korea, MET is the preferred initial oral antidiabetic drug, and it has also been the most commonly prescribed antidiabetic medication since 2010 [4, 5]. In addition, in 2016, >80% of dual therapy regimens included MET as the first-line therapy.…”

Past and Current Status of Adult Type 2 Diabetes Mellitus Management in Korea: A National Health Insurance Service Database Analysis

“…The Clinical Practice Guidelines of the KDA recommend that active lifestyle modification and the appropriate use of antidiabetic agents are needed following the initial diagnosis of T2DM. Metformin is the preferred initial oral antidiabetic agent [ 9 10 ]. Therefore, the proportion of metformin use is expected to be maintained constant at the current level.…”