Building therapy in type 2 diabetes – metformin and beyond

A holistic approach to type 2 diabetes (T2DM) should be undertaken that takes account of an individual’s needs, circumstances and personal preferences. Lifestyle advice and education remain the cornerstone of managing T2DM. If, however, satisfactory glycaemic control cannot be achieved with lifestyle measures alone then pharmacological agents may be tried.^1,2,3

There is strong evidence that good glycaemic control reduces the risk of microvascular complications (nephropathy, retinopathy) and, weaker evidence that it can help avoid atherosclerotic macrovascular disease (myocardial infraction, stroke, peripheral vascular disease).⁴

Metformin – the starting point for pharmacological treatment

Mechanistically, metformin appears to reduce glucose production and release from the liver and improve tissue sensitivity to insulin, allowing increased peripheral glucose uptake. It is effective in improving glycaemic control, typically lowering HbA1c by 11-16 mmol/mol (1-1.5%) in T2DM, improving both fasting and post-prandial plasma glucose.⁵