Abstract
AimsTo determine prospectively the efficacy, tolerability and patient satisfaction of an extended release formulation of metformin (metformin XR) in hospital based outpatients with type 2 diabetes mellitus currently treated with standard metformin.MethodsPatients on immediate release standard metformin either alone or combined with other oral agents were switched to extended release metformin XR 500 mg tablets and titrated to a maximum dose of 2000 mg/day Measurements to include glucose and lipid control, blood pressure, body weight, waist circumference, C-reactive protein, adverse events and patient satisfaction were recorded at baseline, three and six months.ResultsComplete data were obtained for 35 of the 61 patients enrolled to the study. At three and six months no changes were reported for any of the cardiovascular risk factors except for lipids where there was a modest rise in plasma triglycerides. These effects were achieved with a reduced dose of metformin XR compared to pre-study dosing with standard metformin (1500 mg +/- 402 vs 1861 +/- 711 p = 0.004). A total of 77% of patients were free of gastrointestinal side effects and 83% of patients stated a preference for metformin XR at the end of the study. Ghost tablets were reported in the faeces by the majority of the patients (54.1%).ConclusionsPatients switched to extended release metformin XR derived the same clinical and metabolic benefits as for standard metformin but with reduced dosage, fewer gastrointestinal side effects and a greater sense of well being and satisfaction on medication.
Highlights
Type 2 Diabetes Mellitus is a chronic and progressive disease which demands intense management from diagnosis and through the various stages of the disease [1,2]
The effectiveness of the extended release tablet was measured on three cardiovascular risk factors - blood glucose [HbA1c, fasting blood glucose (FBG), and postprandial blood glucose (PPBG)] blood lipids [total cholesterol, LDL cholesterol (Friedwald calculation) HDL cholesterol and triglycerides] and blood pressure
Body weight was measured as Body mass index (BMI), as were the anthropometric measures of waist circumference and waist/hip ratio (WHR)
Summary
Type 2 Diabetes Mellitus is a chronic and progressive disease which demands intense management from diagnosis and through the various stages of the disease [1,2]. Compliance is an issue for all chronic diseases [15] and poor tablet adherence is a particular concern in managing patients with diabetes due to the burden of medication [16,17]. In the 5 point plan for introducing metformin, the ADA/EASD draw attention to the recently introduced extended release metformin. This prospective study sets out to determine the ability of hospital based outpatients with type 2 diabetes to switch from standard metformin to extended release formulation (metformin XR). To assess the resultant benefits on cardiovascular risk factors including glycaemia, plasma lipids, blood pressure, body weight and anthropometric measurements as well as measures of tolerability and patient satisfaction
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