Skip to main content

Advertisement

SpringerLink
Log in

Results of the Adequacy of glycemiC Control in pAtients with type 2 Diabetes mEllitus treated with Metformin monotherapY at the maximal-tolerated dose (ACCADEMY) study

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

The treatment objective in diabetes is prevention of the onset or progression of complications. Intensive treatment reduces the risk of complications. The aim of the study was to evaluate glycemic control in patients with type 2 diabetes mellitus treated with metformin monotherapy at the maximal-tolerated dose. This retrospective, multicenter, observational study, enrolled patients ≥45-year old receiving metformin as monotherapy for at least 36 months. Data were collected on demographic and disease characteristics, clinical status, lifestyle, comorbidities, and diabetes complications at baseline, 9, 18, and 24 months. Primary study variables were percentage of patients achieving HbA1c <7 % and mean HbA1c reduction after 9 months. Eligible patients (n = 524, mean age 65.9 ± 7.9 years) had a mean age at diagnosis of 57.5 ± 7.9 years. A second antidiabetic drug was added in 24 % of patients (126/524); time to treatment escalation was 44.7 ± 25.1 months. Regarding primary study variables, 61.7 % of patients (322/522) achieved HbA1c of 7.0 % at 9 months, compared to 37.0 % of patients (194/524) at baseline; mean HbA1c was reduced from 7.30 ± 0.95 to 6.84 ± 0.86 % after 9 months. The estimated mean time of exposure above 7 % was 19 months, 15 months for patients ≥65-year old, and 21 months for younger patients. Regression analysis revealed that patients with longer disease duration, and patients <65-year old responded less well to metformin. A substantial number of patients continued to receive monotherapy instead of intensified therapy and were exposed to hyperglycemia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. International Diabetes Federation. IDF Diabetes Atlas Sixth Edition, 2014 Update. http://www.idf.org/worlddiabetesday/toolkit/gp/facts-figures. Accessed March 5, 2015

  2. J.S. Skyler, R. Bergenstal, R.O. Bonow, J. Buse, P. Deedwania, E.A. Gale, B.V. Howard, M.S. Kirkman, M. Kosiborod, P. Reaven, R.S. Sherwin, American Diabetes Association; American College of Cardiology Foundation; American Heart Association: intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Diabetes Care 32, 187–192 (2009)

    Article  PubMed  PubMed Central  Google Scholar 

  3. J.B. Brown, G.A. Nichols, A. Perry, The burden of treatment failure in type 2 diabetes. Diabetes Care 27, 1535–1540 (2004)

    Article  PubMed  Google Scholar 

  4. S.E. Inzucchi, R.M. Bergenstal, J.B. Buse, M. Diamant, E. Ferrannini, M. Nauck, A.L. Peters, A. Tsapas, R. Wender, D.R. Matthews, American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 35, 1364–1379 (2012)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. S. Bolen, L. Feldman, J. Vassy, L. Wilson, H.C. Yeh, S. Marinopoulos, C. Wiley, E. Selvin, R. Wilson, E.B. Bass, F.L. Brancati, Systematic review: comparative effectiveness and safety of oral medications for type 2 diabetes mellitus. Ann. Intern. Med. 147, b386–b399 (2007)

    Article  Google Scholar 

  6. W.D. Strain, M. Blüher, P. Paldánius, Clinical inertia in individualising care for diabetes: is there time to do more in type 2 diabetes? Diabetes Ther. 5, 347–354 (2014)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. S.E. Inzucchi, Oral antihyperglycemic therapy for type 2 diabetes: scientific review. JAMA 287, 360–372 (2002)

    Article  CAS  PubMed  Google Scholar 

  8. J.A. Hirst, A.J. Farmer, R. Ali, N.W. Roberts, R.J. Stevens, Quantifying the effect of metformin treatment and dose on glycemic control. Diabetes Care 35, 446–454 (2012)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. K. Zhou, L. Donnelly, J. Yang, M. Li, H. Deshmukh, N. Van Zuydam, E. Ahlqvist, Wellcome Trust Case Control Consortium 2, C.C. Spencer, L. Groop, A.D. Morris, H.M. Colhoun, P.C. Sham, M.I. McCarthy, C.N. Palmer, E.R. Pearson, Heritability of variation in glycaemic response to metformin: a genome-wide complex trait analysis. Lancet Diabetes Endocrinol. 2, 481–487 (2014)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. A.J. Garber, T.G. Duncan, A.M. Goodman, D.J. Mills, J.L. Rohlf, Efficacy of metformin in type II diabetes: results of a double-blind, placebo-controlled, dose-response trial. Am. J. Med. 103, 491–497 (1997)

    Article  CAS  PubMed  Google Scholar 

  11. A.A. Riedel, H. Heien, J. Wogen, C.A. Plauschinat, Loss of glycemic control in patients with type 2 diabetes mellitus who were receiving initial metformin, sulfonylurea, or thiazolidinedione monotherapy. Pharmacotherapy 27, 1102–1110 (2007)

    Article  CAS  PubMed  Google Scholar 

  12. A.J. Garber, D.S. Donovan Jr, P. Dandona, S. Bruce, J.S. Park, Efficacy of glyburide/metformin tablets compared with initial monotherapy in type 2 diabetes. J. Clin. Endocrinol. Metab. 88, 3598–3604 (2003)

    Article  CAS  PubMed  Google Scholar 

  13. L.A. Donnelly, A.S. Doney, A.T. Hattersley, A.D. Morris, E.R. Pearson, The effect of obesity on glycaemic response to metformin or sulphonylureas in Type 2 diabetes. Diabet. Med. 23, 128–133 (2006)

    Article  CAS  PubMed  Google Scholar 

  14. D.P. Martono, R. Lub, H.J. LambersHeerspink, E. Hak, B. Wilffert, P. Denig, Predictors of response in initial users of metformin and sulphonylurea derivatives: a systematic review. Diabetes Med. (2015). doi:10.1111/dme.12688

    Google Scholar 

  15. M.R. Taskinen, J. Borén, New insights into the pathophysiology of dyslipidemia in type 2 diabetes. Atherosclerosis. 239, 483–495 (2015)

    Article  CAS  PubMed  Google Scholar 

  16. C.B. Giorda, Could clinical inertia in part explain the unexpected association of insulin therapy with poorer cardiovascular outcomes in observational studies on diabetes? Diabetes Res. Clin. Pract. 92, e47–e48 (2011)

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Via De Maria, 10023, Chieri, TO, Italy

    Carlo B. Giorda

  2. MSD, Rome, Italy

    Stefania Cercone

  3. Chaira Medica Association, Chieri, Italy

    Elisa Nada

Authors
  1. Carlo B. Giorda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefania Cercone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elisa Nada
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the ACCADEMY Study Group

Corresponding author

Correspondence to Carlo B. Giorda.

Ethics declarations

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

This work was funded by an unrestricted grant by MSD Italia Srl. The sponsor had no role in selecting the participants, reviewing the literature, defining recommendations, drafting or reviewing the paper, or in the decision to submit the manuscript for publication. All views expressed are solely those of the authors. Medical writing assistance was provided by Editamed srl. The authors have no other conflict of interest to declare.

Appendix

Appendix

See Table 3.

Table 3 List of participating Centers for the Accademy Study Group
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Giorda, C.B., Cercone, S., Nada, E. et al. Results of the Adequacy of glycemiC Control in pAtients with type 2 Diabetes mEllitus treated with Metformin monotherapY at the maximal-tolerated dose (ACCADEMY) study. Endocrine 52, 507–515 (2016). https://doi.org/10.1007/s12020-015-0692-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-015-0692-9

Keywords

Search

Navigation