Patterns and Predictors of Metformin Monotherapy Ineffectiveness: A Study of Alternative Antidiabetic Treatment Responses
Author(s)
Dhriti Sahu, PharmD1, Chandan A, Pharm D2, J M Srushti, Pharm D3, Rashmi Raman, Pharm D4, Kshreeraja S. Satish, Pharm D4.
1Student, M S Ramaiah University Of Applied Sciences, Bangalore, India, 2Pharmacy Practice, MS Ramaiah University of Applied Science, Bangalore, India, 3Pharmacy Practice, M S Ramaiah University Of Applied Sciences, Bangalore, India, 4M S Ramaiah University Of Applied Sciences, Bangalore, India.
1Student, M S Ramaiah University Of Applied Sciences, Bangalore, India, 2Pharmacy Practice, MS Ramaiah University of Applied Science, Bangalore, India, 3Pharmacy Practice, M S Ramaiah University Of Applied Sciences, Bangalore, India, 4M S Ramaiah University Of Applied Sciences, Bangalore, India.
OBJECTIVES: Type 2 diabetes mellitus (T2DM) is managed with metformin as the first line therapy. A significant number of patients experience metformin monotherapy failure (MMF) . Recognizing the factors associated with MMF is essential for implementing timely interventions—such as lifestyle modifications, switching to alternative agents—to maintain effective glycemic control. This study aims to identify the major predictors of MMF and assess the outcomes and effectiveness of various alternative therapeutic strategies.
METHODS: This prospective study included 196 T2DM patients on MMF, followed from baseline until MMF. Potential causes such as adverse reactions and drug interactions were assessed, and appropriate strategies implemented in consultation with physicians. Post-MMF, alternative therapies were documented, and patients were followed for three months to evaluate treatment outcomes, classified as improved, worsened, or unchanged based on HbA1c changes.
RESULTS: 196 patients with type 2 diabetes taking metformin, 38.8% experienced m MMF. Key factors linked to this failure included higher starting HbA1c levels, poor diet, low medication adherence, and the presence of kidney problems. After MMF, the most commonly prescribed treatment was a combination of metformin and glimepiride. Over six months, patients who were switched to insulin or triple therapy showed better improvement in blood sugar levels. On average, HbA1c dropped by 0.66 to 1.5 mmol/mol with triple therapy and 1.57 mmol/mol with insulin.
CONCLUSIONS: This study emphasizes the importance of checking baseline HbA1c and kidney function before starting metformin. Educating patients on medication adherence and diet is key to better blood sugar control. After MMF, insulin and triple therapy were most effective, with triple therapy being a good option for those unwilling to start insulin. As this was a single-center study with a small sample and only HbA1c used for assessment, future research should include more factors, compare treatment options, and evaluate both effectiveness and safety
METHODS: This prospective study included 196 T2DM patients on MMF, followed from baseline until MMF. Potential causes such as adverse reactions and drug interactions were assessed, and appropriate strategies implemented in consultation with physicians. Post-MMF, alternative therapies were documented, and patients were followed for three months to evaluate treatment outcomes, classified as improved, worsened, or unchanged based on HbA1c changes.
RESULTS: 196 patients with type 2 diabetes taking metformin, 38.8% experienced m MMF. Key factors linked to this failure included higher starting HbA1c levels, poor diet, low medication adherence, and the presence of kidney problems. After MMF, the most commonly prescribed treatment was a combination of metformin and glimepiride. Over six months, patients who were switched to insulin or triple therapy showed better improvement in blood sugar levels. On average, HbA1c dropped by 0.66 to 1.5 mmol/mol with triple therapy and 1.57 mmol/mol with insulin.
CONCLUSIONS: This study emphasizes the importance of checking baseline HbA1c and kidney function before starting metformin. Educating patients on medication adherence and diet is key to better blood sugar control. After MMF, insulin and triple therapy were most effective, with triple therapy being a good option for those unwilling to start insulin. As this was a single-center study with a small sample and only HbA1c used for assessment, future research should include more factors, compare treatment options, and evaluate both effectiveness and safety
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
PCR184
Topic
Patient-Centered Research
Topic Subcategory
Adherence, Persistence, & Compliance, Health State Utilities, Instrument Development, Validation, & Translation, Patient-reported Outcomes & Quality of Life Outcomes
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), No Additional Disease & Conditions/Specialized Treatment Areas