A RETROSPECTIVE CHART REVIEW OF UNCONTROLLED USE OF METFORMIN AS AN ADD-ON THERAPY IN TYPE-2 DIABETES

The hyperglycemia, hyperinsulinemia, insulin resistance, and obesity s yndrome associated with type 2 diabetes can have debilitating conseque nces. The biguanide metformin has a mechanism of action that is comple mentary to those of insulin and the sulfonylureas, suggesting that com bination therapy that includes metformin may result in improved glycem ic control. The purpose of this retrospective chart review was to dete rmine the effects of adding metformin in an uncontrolled fashion to ex isting therapy in obese patients with type 2 diabetes who had suboptim al glycemic control and insulin resistance. For the review, the record s of 124 patients were divided into two groups: group 1 included 71 pa tients who were taking insulin with or without a sulfonylurea, and gro up 2 consisted of 53 patients who were taking a sulfonylurea alone. Me tformin was added to patients' existing therapy in conjunction with do wnward titration of the sulfonylurea and insulin doses. A retrospectiv e chart review was conducted at the end of 6 months for group 1 and at the end of 12 months for group 2 to determine the change from baselin e in measures of diabetes control tie, insulin and sulfonylurea dose, glycated hemoglobin [Hb A(1c)] value, body mass index [BMI], and Lipid profiles). In group 1, the mean insulin dose decreased from 46.4 U/d at baseline to 6.1 U/d at the end of followup. Eighty-three percent of the patients were able to discontinue insulin therapy completely Simi larly, group 2 had statistically significant reductions in mean sulfon ylurea dose. Both groups also achieved statistically significant reduc tions in Hb A(1c), BMI, and total cholesterol level. The addition of m etformin to treatment with insulin or sulfonylureas, either alone or i n combination, significantly improved glycemic control and cholesterol levels and promoted weight loss in obese type 2 diabetic patients wit h insulin resistance. Less than 5% of patients reported mild, transien t gastrointestinal side effects, none of which required cessation of m etformin therapy. Five patients discontinued metformin due to lack of efficacy.