Are oral hypoglycemic agents suitable as the first-line treatment for newly diagnosed type 2 diabetes in patients with severe hyperglycemia?

Objectives: To investigate if starting oral antihyperglycemic agent was enough to achieve the target glycated hemoglobin (HbA1c) in patients with newly diagnosed type 2 diabetes mellitus (T2DM), despite severe hyperglycemia, with or without symptoms. Patients and Methods: This was a retrospective patient data analysis for patients with newly diagnosed T2DM during January to December 2013. At baseline and after 3 months, HbA1c was measured. All patients started a diet and lifestyle changes in addition to oral hypoglycemic agents. Results: The enrolled patients were 764 in number. Of them, 331 (42.9%) achieved the target HbA1c <7% by oral hypoglycemic agents after 3 months, regardless of the treatment used. Multivariable logistic regression analysis showed that only presenting fasting plasma glucose <150 mg (odds ratio [OR] 2.193, 95% confidence interval [CI] 1.297–3.709) and drug treatment (OR 1.320, 95% CI 1.100–1.585) were the independent variables associated with achieving the glycemic target. Conclusions: Using antihyperglycemic agents as the first line for new T2DM, 42.9% patients can achieve target glycemic control. Even those with gross glycemic abnormalities, more than 60%, can achieve target glycemic control using diet, lifestyle change, and metformin. Prospective trials are needed to confirm such findings.

Key-words:

Glycated hemoglobin - oral hypoglycemic agents - type 2 diabetes