Real-World Clinical Experience on the Usage of High-Dose Metformin (1500-2500 mg/day) in Type 2 Diabetes Management

Abstract

Background: To evaluate the clinical characteristics, treatment patterns, and clinical effectiveness and safety of high doses of metformin (1500-2500 mg/day) in Indian adults with type 2 diabetes mellitus (T2DM). Materials and methods: A retrospective, multicentric (n = 241), real-world study included patients with T2DM (aged >18 years) receiving high doses of metformin. Details were retrieved from patient’s medical records. Results: Out of 5695 patients, 62.7% were men with median age was 50.0 years. Hypertension (67.5%) and dyslipidemia (48.7%) were the prevalent comorbidities. Doses of 2000 mg (57.4%) and 1500 mg (29.1%) were the most commonly used doses of metformin and median duration of high-dose metformin therapy was 24.0 months. Metformin twice daily was the most frequently used dosage pattern (94.2%). Up-titration of doses was done in 96.8% of patients. The mean HbA1c levels were significantly decreased post-treatment (mean change: 1.08%; P < .001). The target glycemic control was achieved in 91.2% patients. A total of 83.0% had decreased weight. Adverse events were reported in 156 patients. Physician global evaluation of efficacy and tolerability showed majority of patients on a good to excellent scale (98.2% and 97.7%). Conclusion: Clinical effectiveness and safety of a high-dose metformin was demonstrated through significant improvement in HbA1c levels and weight reduction.

Clinical efficacy and cost‐effectiveness of metformin in different patient populations: A narrative review of real‐world evidence

“…24 Furthermore, in a real-world study across 241 centres in India (n = 5695), metformin therapy reduced HbA1c from 67 to 55 mmol/mol, with a mean change from baseline of 12 mmol/mol. 25 Although a direct comparison between Asian and non-Asian T2D subjects on metformin monotherapy is still lacking, these recent results support consistent efficacy across ethnic/racial groups.…”

“…Yet, among 5503 Asians (75% Chinese) followed in a primary care setting, metformin monotherapy induced an absolute reduction in HbA1c of approximately 5, 11 and 22 mmol/mol in PwD with progressively greater baseline HbA1c levels of 53–64 mmol/mol, 64–75 mmol/mol, or above 75 mmol/mol, respectively 24 . Furthermore, in a real‐world study across 241 centres in India ( n = 5695), metformin therapy reduced HbA1c from 67 to 55 mmol/mol, with a mean change from baseline of 12 mmol/mol 25 . Although a direct comparison between Asian and non‐Asian T2D subjects on metformin monotherapy is still lacking, these recent results support consistent efficacy across ethnic/racial groups.…”

Efficacy of metformin monotherapy in newly diagnosed type 2 diabetes mellitus patients treated at Prince Mohammed Bin Abdulaziz hospital, Riyadh, Saudi Arabia

“…In Saudi Arabian hospitals, metformin is usually prescribed for both newly diagnosed and long-term diabetes patients. 17 A recent retrospective study done in the Kingdom of Saudi Arabia by Al-Rubeaan et al reported that among 519 Saudi type 2 diabetics 89.2% were prescribed metformin as the first line of treatment which shows that the majority of physicians still consider metformin as the best option in diabetes management. 18 Various meta-analyses and systemic reviews have described metformin's role in glycemic control shown by reduced HbA1c levels by an average of 1 to 2% in most cases.…”

Scrophulariae Radix-Atractylodes sinensis pair and metformin inhibit inflammation by modulating gut microbiota of high-fat diet/streptozotocin-induced diabetes in rats

“…MET has multiple activities and excellent therapeutic efficacy in different pathological environments (Das et al, 2021;Drzewoski and Hanefeld, 2021;Rajgopal and Kochhar, 2021). However, most patients under long-term MET treatment (>10 years) have poor blood glucose control (Cherney and Lam, 2018).…”

“…It exhibits anti-diabetic effects by changing gut microbial communities ( Cherney and Lam, 2018 ; Guo and Xie, 2018 ; Sun et al, 2018 ; Vallianou et al, 2019 ). MET has multiple activities and excellent therapeutic efficacy in different pathological environments ( Das et al, 2021 ; Drzewoski and Hanefeld, 2021 ; Rajgopal and Kochhar, 2021 ). However, most patients under long-term MET treatment (>10 years) have poor blood glucose control ( Cherney and Lam, 2018 ).…”