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ACP issues new clinical practice guideline for drug
treatment of type 2 diabetes
Guideline | Read Patient
PHILADELPHIA, February 7, 2012 -- The American College of
Physicians (ACP) recommends that clinicians add metformin as the
initial drug treatment for most patients with type 2 diabetes when
lifestyle modifications such as diet, exercise, and weight loss
have failed to adequately improve high blood sugar.
ACP also recommends that clinicians add a second drug to
metformin when treatment with metformin and lifestyle changes fail
to control blood sugar levels. Citing insufficient evidence, ACP
does not recommend one class of drug over another as a second
The recommendations are part of a new ACP clinical practice
guideline published today in Annals of Internal Medicine,
ACP's flagship journal. ACP developed the guideline based on an
analysis of the comparative effectiveness and safety of different
classes of oral diabetes drugs approved by the US Food and Drug
Administration for the treatment of high blood sugar in people with
type 2 diabetes: metformin, sulfonylureas, meglitinides,
thiazolidinediones, DPP-4 inhibitors, and GLP-1 receptor
ACP evaluated the evidence of the impact of high blood sugar
levels on clinical outcomes such as body weight, cholesterol and
triglyceride levels, all-cause mortality, cardiovascular disease
and death, neuropathy, and kidney function.
"We found that most diabetes medications reduced blood sugar
levels to a similar degree," said Amir Qaseem, MD, FACP, PhD, MHA,
Director of Clinical Policy at ACP. "However, metformin is more
effective compared to other type 2 diabetes drugs in reducing blood
sugar levels when used alone and in combination with other drugs.
In addition, metformin reduces body weight and improves cholesterol
For side effects, the risk for dangerously low blood sugar
levels was higher with sulfonylureas than with other type 2
diabetes drugs. Metformin was associated with fewer side effects
The evidence was insufficient to show any difference in
effectiveness between various medications across subgroups of
adults, such as age, sex, or race.
The guideline includes a Best Practice Advice section to help
clinicians practice high value,
cost-conscious care. ACP recommends prescribing generic
metformin because it has better effectiveness than the majority of
the other medications; is associated with fewer adverse effects,
including that it does not result in weight gain; and is less
The guideline notes that good management of type 2 diabetes
includes patient education. A patient summary
of the guideline is available online.
The American College of Physicians is the largest medical
specialty organization and the second-largest physician group in
the United States. ACP members include 132,000 internal medicine
physicians (internists), related subspecialists, and medical
students. Internists specialize in the prevention, detection, and
treatment of illness in adults. Follow ACP on Twitter and Facebook.