Hormonal
In drug-naive patients with prediabetes, initiating GLP-1 RA as first-line therapy significantly reduces the 1-year risk of requiring additional glucose-lowering medication compared to metformin, but is associated with a significantly higher risk of treatment nonadherence.
For patients with prediabetes, GLP-1 RA is more effective than metformin at preventing the need for extra diabetes medications over one year. However, patients are more likely to stop taking GLP-1 RA than metformin. Clinicians should proactively manage expectations regarding side effects and adherence to maximize the benefit.
GLP-1 RA initiation in those with prediabetes was associated with a 1-year risk of add-on glucose-lowering therapy of 0.99%... whereas metformin initiation was associated with a risk of add-on glucose-lowering therapy of 3.68%... GLP-1 RA initiation in patients with prediabetes was associated with a 1-year risk of 55.68%... of nonadherence, whereas the risk associated with metformin initiation was 34.79%... yielding a RR of 1.60
Why this rating
Large nationwide cohort study (n=3556) with rigorous matching and adjustment, though observational design limits causal inference compared to RCTs.
Source
Comparing Glucagon‐like peptide‐1 receptor agonists versus metformin in drug‐naive patients: A nationwide cohort study
Kathrine Kold Sørensen et al. · Journal of Diabetes · 2024
DOI 10.1111/1753-0407.70000
More from this paper
- In drug-naive patients with diabetes, initiating GLP-1 RA as first-line therapy reduces the 1-year risk of requiring additional glucose-lowering medication compared to metformin, with no significant difference in adherence rates.Good
- First-line GLP-1 RA initiation is associated with greater HbA1c reduction compared to metformin in both patients with prediabetes and diabetes.Good
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