The Effectiveness of Metformin versus Glyburide in Type 2 Diabetes: Results from ADOPT (A Diabetes Outcomes Progression Trial)

Herman, William H.; Haffner, Steven M.; Kahn, Steven E.; Zinman, Bernard; Holman, Rury R.; Viberti, Giancarlo F.; Lachin, John M.; Kravitz, Barbara G.; Heise, Mark A.
June 2007
Diabetes;Jun2007 Supplement 1, Vol. 56, pA146
Academic Journal
ADOPT compared initial oral monotherapies in recently diagnosed type 2 diabetic patients and found rosiglitazone to be superior to metformin (Met) and glyburide (Gly) as assessed by time to monotherapy failure (MF), defined as time to the first of two successive fasting plasma glucose (FPG) values >180 mg/dl. Previously, the UKPDS compared Met and sulfonylurea treatment in overweight patients (≥120% ideal body weight, mean BMI 31.4 kg/m²) and found that the A1c responses to therapy were similar. We present here the ADOPT results comparing the efficacy of Met and Gly, which was a prespecified secondary analysis. Eligible patients had type 2 diabetes diagnosed within 3 years, were 30-75 years of age, and had FPG levels between 126-180 mg/dl with lifestyle management alone. Mean BMI was 32.2 kg/m². 1454 patients were randomized to Met and 1441 to Gly. Study medication was titrated to a total daily dose of 2 g Met or 15 mg Gly. Compared to Gly, Met reduced the risk of MF by 46.5% (p<0.01). At 4 years, 36% in the Met group and 26% in the Gly group remained on monotherapy and had A1c <7% (p<0.01). From a longitudinal linear model, mean A1c <7% was maintained until the 45 month visit in the Met group and the 33 month visit in the Gly group. More Met-treated patients experienced gastrointestinal adverse events (38% vs. 22%, p<0.01) but fewer experienced hypoglycemia (12% vs. 39%, p<0.01). There was weight gain at 4 years with Gly but not with Met (1.81 kg vs -2.53 kg, p<0.01). In conclusion, ADOPT demonstrated that in recently diagnosed patients with type 2 diabetes, Met is more effective than Gly, providing more durable glycemic control with less hypoglycemia and no weight gain.


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