(HealthDay News) — Patients with newly diagnosed type 2 diabetes who are initially prescribed metformin are less likely to eventually need other medications to control their blood glucose, according to research published in JAMA Internal Medicine.

Niteesh Choudhry, MD, of the Harvard Medical School in Boston, and colleagues collected data on 15,516 people starting treatment for type 2 diabetes from July 2009 through June 2013. The average follow-up time was slightly longer than 1 year. 

Of those patients, 57.8% were initially treated with metformin, and about one-quarter began treatment with a sulfonylurea. Just 6% were started with a thiazolidinedione and 13% with a dipeptidyl peptidase 4 inhibitor (DPP-4) inhibitor.

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Around 40% of people taking a sulfonylurea, a thiazolidinedione or a DPP-4 inhibitor added a second drug to their diabetes treatment regimen during the study, according to the researchers. However, just 25% of those on metformin added an additional oral medication during the study period. 

In addition, 5% of those started on metformin later added insulin to their treatment, according to the study. About 9% of those who started on a sulfonylurea, 6% of those who started on a DPP-4 inhibitor and 6% of those who started on thiazolidinediones, also took insulin.

Choudhry said that many patients are being started on other drugs, but this study indicates that treatment should start with metformin. 

“This study supports the predominant practice, which is that most people are started on metformin,” Choudhry told HealthDay

“Metformin, which is one of the oldest drugs we have and which the guidelines recommend as being the first drug to use, is associated with a lower risk of needing to add a second drug or insulin compared to any of three other commonly used classes of drugs.”


  1. Berkowitz SA et al. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.5294.