title: Failure to metformin and insulin secretagogue monotherapy: an observational cohort study.
abstract: The aim of the present cohort study is the assessment of treatment failure rates in patients on monotherapy with metformin or insulin secretagogues, observed in a routine clinical setting. A cohort of patients without any pharmacological treatment was also observed. A retrospective observational cohort study was performed on a consecutive series of 2,020 type 2 diabetic patients receiving monotherapy with an oral agent (metformin or insulin secretagogue, n = 1,126) or drug-naive (n = 894). HbA1c and prescribed hypoglycemic therapy were recorded yearly. Patients were followed until death, change of residence, failure to treatment, or up to 48 months. The mean duration of follow up was 34.8 ± 18.0 months. In a Cox regression analysis, metformin was associated with a significant reduction, and insulin secretagogues with a significant increase, in the risk of failure to therapy during follow up. When duration of diabetes and baseline BMI were added to the model, insulin secretagogues, but not metformin, were still associated with increased risk of failure. In conclusion, insulin secretagogues are associated with increased failure rate in comparison with metformin. This difference could be due to detrimental effect of secretagogues, rather than to a beneficial action of metformin.
authors.affiliation: Section of Endocrinology, Department of Clinical Pathophysiology, University of Florence and Azienda Ospedaliera Careggi, Florence, Italy. l.pala@dfc.unifi.it
authors.forename: Laura
authors.initials: L
authors.lastname: Pala
authors.forename: Matteo
authors.initials: M
authors.lastname: Monami
authors.forename: Caterina
authors.initials: C
authors.lastname: Lamanna
authors.forename: Barbara
authors.initials: B
authors.lastname: Cresci
authors.forename: Claudia
authors.initials: C
authors.lastname: Colombi
authors.forename: Gianluca
authors.initials: G
authors.lastname: Bardini
authors.forename: Jolanda
authors.initials: J
authors.lastname: Sposato
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.forename: Carlo M
authors.initials: CM
authors.lastname: Rotella
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008687:Metformin / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin