Management of an Adult With Type 2 Diabetes With Antidiabetic Medications: A Case Scenario
Treatment Decision: Adverse Effects Associated With Metformin Monotherapy
While reviewing the consumer research review, the patient asks about possible side effects of taking metformin. You tell him that the most important adverse effect of metformin is:
Discussion of Answers:
A. Incorrect. Explanation: According to current research, there is moderate and high strength evidence that metformin maintains or decreases weight when compared to several other monotherapies (thiazolidinediones, second-generation sulfonylureas, and dipeptidyl peptidase-4 (DPP-4) inhibitors.
B. Incorrect. Explanation: There is moderate to high strength of evidence that the risk of mild to moderate hypoglycemia is lower in metformin than other monotherapy antidiabetic agents (meglitinides and second-generation sulfonylureas). There is also moderate strength of evidence that metformin and thiazolidinediones have a similar risk for mild to moderate hypoglycemia.
C. Correct. Explanation: High and moderate strength of evidence shows that metformin is associated with more frequent GI adverse events compared with several other monotherapies (thiazolidinediones, second-generation sulfonylureas, and dipeptidyl peptidase-4 (DPP-4) inhibitors). These adverse events were mainly diarrhea that were worse at the initiation of treatment and improved if the patient took metformin with meals and had a slow titration of the dosage.
D. Incorrect. Explanation: There is high strength of evidence that metformin is associated with significantly lower rates of hip and nonhip fractures when compared with thiazolidinediones.
E. Incorrect. Explanation: There is moderate strength of evidence that there is only a low risk of severe lactic acidosis for adults with type 2 diabetes who are treated with metformin monotherapy.
Keywords: adverse effects | gastrointestinal adverse events | hypoglycemia | metformin | treatment decision
- Bennett WL, Wilson LM, Bolen S, et al. Oral Diabetes Medications for Adults With Type 2 Diabetes: An Update. Comparative Effectiveness Review No. 27. (Prepared by Johns Hopkins University Evidence-based Practice Center under Contract No. 290-02-0018.) AHRQ Publication No. 11-EHC038-EF. Rockville, MD: Agency for Healthcare Research and Quality. March 2011. Available at: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=644.
- Comparing Medications for Adults With Type 2 Diabetes. Rockville, MD: Agency for Healthcare Research and Quality. AHRQ Pub. No. 11-EHC038-3. June 2011. Available at: http://www.effectivehealthcare.ahrq.gov.
- Medicines for Type 2 Diabetes, A Review of the Research for Adults. Rockville, MD: Agency for Healthcare Research and Quality. AHRQ Pub. No. 11-EHC038-A. June 2011. Available at: http://www.effectivehealthcare.ahrq.gov.
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