Dose distribution and up‐titration patterns of metformin monotherapy in patients with type 2 diabetes

摘要

Aims To assess the dose distribution among users of metformin monotherapy as well as the patterns of up‐titration following initiation of therapy in people with type 2 diabetes mellitus (T2DM). Materials and Methods This was a retrospective cohort study of adults with T2DM in the United Kingdom (UK). Metformin dose distribution was assessed at 0, 6 and 12?months in people initiating metformin monotherapy (new users) and cross‐sectionally in people with ongoing metformin monotherapy (prevalent users). Patterns and predictors of up‐titration were also analysed in new users. Dose distributions and treatment patterns were assessed descriptively; predictors of up‐titration were determined using multivariable logistic regressions. Results Totals of 6174 new users and 8733 prevalent users were included. New users initiated metformin at 0?mg to ≤500?mg (25%), 500?mg to ≤1000?mg (47%), 1000?mg to ≤1500?mg (17%) or 1500?mg to ≤2000?mg (12%) daily. This distribution did not vary over time. Prevalent users of metformin received doses of 0?mg to ≤500?mg (14%), 500?mg to ≤1000?mg (40%), 1000?mg to ≤1500?mg (15%), 1500?mg to ≤2000?mg (29%) or 2000?mg (1%) daily. Among new users of metformin, 6.7% and 10.8% had been up‐titrated at 6 and 12?months, respectively, despite the majority having glycated haemoglobin 53?mmol/mol. Predictors of up‐titration included younger age and higher HbA1c. Conclusions A majority of T2DM patients taking metformin received a dose ≤1000?mg/day. Up‐titration of metformin is infrequent in the first year postinitiation.