Pharmacy, Health Sciences, & Exercise Science
Secondary Agents as Add-On Therapy to Metformin in Type 2 Diabetes Mellitus: A Quality Improvement Study
Document Type
Poster Presentation
Location
Indianapolis, IN
Start Date
13-4-2018 8:30 AM
End Date
13-4-2018 10:00 AM
Sponsor
Alison Walton (Butler University)
Description
Current guidelines and clinical studies for the treatment of Type 2 Diabetes Mellitus (T2DM) all support the use of metformin as the recommended initial agent over other medication classes available. However, there is no standard recommendation regarding the next best medication class to initiate as add-on therapy. The purpose of this quality improvement study was to describe the most common prescribing habits for physicians in the St. Vincent Wellness Centers at Zionsville Community Schools (ZCS) and Carmel Clay Schools (CCS) regarding add-on therapy to metformin. Patients were included if they had an A1c ≥ 6.5%, ages 18 and older, and who were prescribed metformin. Patients were excluded if they were < 18 years old, type 1 diabetics, had an eGFR ≤ 30 ml/min/1.73 m2, or pregnant. The medication classes evaluated include sulfonylureas, thiazolidinediones, DPP-4 inhibitors, SGLT-2 inhibitors, GLP-1 agonists, and basal insulin. A total of 63 patients were evaluated. Within CCS, 39 of 40 patients received at least 1 secondary agent in addition to metformin. The most common medications used as add-on therapy were sulfonylureas (23%), DPP-4 inhibitors (21%), and basal insulin (21%). Similar results were seen within ZCS, with 20 of 23 patients having received at least 1 secondary agent. Sulfonylureas (29%) and DPP-4 inhibitors (29%) were the most common medications used as add-on therapy. These results may suggest that sulfonylurea and DPP-4 inhibitor use is less effective at lowering a patient’s A1c when added to metformin, compared to other agents.
Secondary Agents as Add-On Therapy to Metformin in Type 2 Diabetes Mellitus: A Quality Improvement Study
Indianapolis, IN
Current guidelines and clinical studies for the treatment of Type 2 Diabetes Mellitus (T2DM) all support the use of metformin as the recommended initial agent over other medication classes available. However, there is no standard recommendation regarding the next best medication class to initiate as add-on therapy. The purpose of this quality improvement study was to describe the most common prescribing habits for physicians in the St. Vincent Wellness Centers at Zionsville Community Schools (ZCS) and Carmel Clay Schools (CCS) regarding add-on therapy to metformin. Patients were included if they had an A1c ≥ 6.5%, ages 18 and older, and who were prescribed metformin. Patients were excluded if they were < 18 years old, type 1 diabetics, had an eGFR ≤ 30 ml/min/1.73 m2, or pregnant. The medication classes evaluated include sulfonylureas, thiazolidinediones, DPP-4 inhibitors, SGLT-2 inhibitors, GLP-1 agonists, and basal insulin. A total of 63 patients were evaluated. Within CCS, 39 of 40 patients received at least 1 secondary agent in addition to metformin. The most common medications used as add-on therapy were sulfonylureas (23%), DPP-4 inhibitors (21%), and basal insulin (21%). Similar results were seen within ZCS, with 20 of 23 patients having received at least 1 secondary agent. Sulfonylureas (29%) and DPP-4 inhibitors (29%) were the most common medications used as add-on therapy. These results may suggest that sulfonylurea and DPP-4 inhibitor use is less effective at lowering a patient’s A1c when added to metformin, compared to other agents.