Glycemic response trajectories on metformin monotherapy in real-world diabetes care
Abstract
Objectives: Diabetes affects over 500 million people globally and glycemia is inadequately managed. Metformin is the most frequently prescribed initial treatment for type 2 diabetes globally, yet glycemic response trajectories to metformin in routine real-world care and predictors of treatment response have not been well described. We aimed to identify glycemic response trajectories in adults prescribed metformin monotherapy as initial type 2 diabetes treatment and predictors of poor glycemic response to metformin.
Design: Observational cohort study using latent class mixed models to identify hemoglobin A1c (HbA1c) trajectory classes, followed by random forests machine learning to predict trajectory class membership.
Setting: US Veterans Affairs Healthcare System
Participants: Adults treated with metformin alone for >30 days after diabetes diagnosis with a minimum of two HbA1c measurements from 90 days prior to two years after the first metformin prescription (N=140,413).
Exposures: Demographic, laboratory, vital sign, and comorbidity data were included as predictors of metformin response trajectory
Main Outcomes and Measures: We included all HbA1c measurements (487,604 total) for two years after metformin initiation to define metformin glycemic response trajectories.
Results: We identified three HbA1c trajectories: stably low (89.7% of sample, mean HbA1c decrease from 7.2% to 6.6%), brisk response (7.1% of sample, mean HbA1c decrease from 11.4% to 7.0%), and non-response…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 140,413 participants or records.
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