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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SR Metformin offers no benefit

Diabetes Care has published a paper comparing immediate release (IR) metformin to a once-daily extended-release product (Glumetza)®.

The study recruited patients with Type II Diabetes with elevated HbA1c and fasting plasma glucose (FPG). Approximately 50% of the patients were treatment naive, 25% had been on metformin monotherapy, 15% on sulphonylurea monotherapy and 10% on a combination of metformin and sulphonylurea. Patients were randomised to one of four treatment options as follows:

  • Metformin SR 1500mg once daily
  • Metformin SR 1500mg twice daily
  • Metformin SR 2000mg once daily
  • Metformin IR 1500mg twice daily

Comparable reductions were seen in HbA1c and FPG in all groups and the rate of adverse gastrointestinal events was also similar in all groups. There was more nausea reported in the IR metformin group however discontinuation rates were not statistically different between the groups.

The product used in this study is not available in the UK however there is a sustained release version of metformin (Glucophage SR)® that also failed to demonstrate superior tolerability in a randomised controlled trial. As reported earlier, the Scottish Medicines Consortium rejected Glucophage SR for use on the NHS in Scotland.

Action: IR Metformin remains the first line treatment choice in patients with Type II Diabetes. SR Metformin fails to offer any advantages over IR Metformin.

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4 Comments to “SR Metformin offers no benefit”

  1. A new natural medication, Sucanon is just as effective but without the dangerous adverse effects of other drugs. It will be available for sale in Canada and USA in February 2012.

    Comment by MarkB — January 18, 2012 #

    1. @Mark,

      Having briefly looked at the website for this product I have to say I'm very skeptical. The studies look exclusively at surrogate outcomes, nowhere can I find the name of the active ingredient, the studies are not linked from the site to a peer reviewed medical journal and for a medicine to claim it has no effects is totally unbelievable. In short it looks like nonsense, if it is really that good why is it not revolutionising the treatment of diabetes? Answer, because it really isn't that good in the first place.

      Comment by Matthew Robinson — January 18, 2012 #

  2. +1 to the above comment, i can take the sr and have no side effects, with normal metformin i had allot of digestive problems.

    Comment by chris wray — April 2, 2010 #

  3. I took IR Metformin for 5 years and they were five years of misery. Absolute Diarrhea (frequent lose/liquid bowel movements) made my life unbearable. I couldn't even leave the house for the fear of a sudden onset of diarrhea. I was even given Citilapram to overcome my anxiety, stupid really, I was better off without the Metform.

    Having now taken Gliclazide and Rosiglitazone for 5 years I have recently stopped taking Rosiglitazone (it didn't make a jot of difference to my blood sugar readings anyway)and I'm taking SR Metformin and the side effects couldn't be more different.

    If anything I am slightly constipated, I just eat prunes, works a treat. In my case, I'm pleased I don't live in Scotland. I know I'm not the only one who suffered taking while taking IR Metformin, taking SR Metformin has made a profound difference.

    Comment by Graham Jones — November 16, 2008 #

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