(HealthDay News) – In patients with type 2 diabetes whose blood sugar cannot be controlled by lifestyle modifications such as diet and exercise, metformin monotherapy should be prescribed initially, according to new guidelines from the American College of Physicians (ACP) published in the Feb. 7 issue of the Annals of Internal Medicine.

Amir Qaseem, M.D., Ph.D., M.H.A., from the ACP in Philadelphia, and colleagues reviewed the literature from 1966 to 2010 on the comparative effectiveness and safety of eleven different classes of oral pharmacologic agents, approved by the U.S. Food and Drug Administration for the treatment of hyperglycemia in type 2 diabetes.

The researchers made three strong recommendations based on high-quality evidence: to add oral diabetes medications when lifestyle modifications do not adequately improve hyperglycemia; to prescribe metformin monotherapy initially for most patients; and to add a second drug if lifestyle modifications and metformin monotherapy fail to control hyperglycemia.

“On the basis of the evidence reviewed in this paper, ACP has found strong evidence that in most patients with type 2 diabetes in whom lifestyle modifications have failed to adequately improve hyperglycemia, oral pharmacologic therapy with metformin (unless contraindicated) is an effective management strategy,” Qaseem and colleagues conclude. “It is cheaper than most other pharmacologic agents, has better effectiveness, and is associated with fewer adverse effects; of note, it does not result in weight gain.”

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