Metformin - achieve fasting blood glucose <6.0mmol/l vs diet alone - achieve fasting blood glucose, 15mmol/l

Medication/Intervention

Metformin to achieve fasting blood glucose <6.0mmol/l (maximum dose 2550mg)

Glibenclamide was added if this was not achieved and if unsuccessful changed to insulin to achieve fasting blood glucose <6.0mmol/l (or 7.0 if on insulin)

Comparator

Diet alone to achieve fasting blood glucose <15mmol/l. 

If unsuccessful sulphonylurea (chlor-propamide or glibenclamide) or metformin or insulin to achieve fasting blood glucose <15mmol/l could be added

Study population:

Newly diagnosed type 2 diabetes patients  - between 25-65 years  
Overweight defined as >120% ideal body weight

Comments:

Mean age of patients was 53 years; mean weight 87kg ; BMI 31

Any diabetes-related endpoint or death was defined as for the scenario above sudden death, death from hyperglycaemia or hypoglycaemia, fatal or non-fatal myocardial infarction, angina, heart failure, stroke, renal failure, amputation [of at least one digit], vitreous haemorrhage, retinopathy requiring photocoagulation, blindness in one eye, or cataract extraction

Median HbA_1c during 10 years was 7.4% in metformin group and 8.0% in conventional group

Hypoglycaemic episodes were higher in metformin group compared to diet alone but lower than the sulphonylurea group.  Hypoglycaemia rates increased over time in insulin group as higher doses were required