Solutions to Clinical Medical Challenges and Public Health Challenges

Background: Metformin mono- or combination therapies are the most common form of drug therapies used in managing type 2 diabetes. They are usually prescribed after exercise of some sort has been recommended. It is not always clear exactly how much glycaemic control is achieved by using these drugs or exercise.Objectives: To assess the relative efficacies of Metformin mono- and combination therapies and exercise in controlling diabetes type 2.Search strategy: Trials were identified by searching Pubmed and conducting manual searches of bibliographies.Selection Criteria: Randomised controlled trials and retrospective studies investigating the use of Metformin mono- or combination therapies in the treatment of diabetes type 2 with the reduction of HbA1c as a primary outcome.Data Collection and Analysis: As far as could be obtained, mean changes in HbA1c levels were obtained from all the trials and the percentage of participants who achieved HbA1c levels ≤7% were noted. Any side effects were also recorded.Main results: Seven trials including six randomised controlled trials and one retrospective study involving a total of 1807 patients. The trials lasted between 14 weeks and 52 weeks. Metformin mono-and combination therapies were shown to achieve mean reductions in HbA1c levels of between 0.6% and 2.7% compared to a mean reduction of 0.6% when using exercise alone.Conclusion: Exercise constitutes a clinically significant first line treatment of diabetes type 2 especially in its mild forms achieving both noteworthy reductions in HbA1c levels and ameliorating the effects of the disease. The use of Metformin in mono- or combination therapies however causes superior glycaemic control with reduction in mean HbA1c levels of up to 2.7%. This can be particularly useful when treating acute diabetes type 2. Read more