The National Electronic Library for Medicines has published an 'In-Focus' review of ADOPT (A Diabetes Outcome Progression Trial).
As previously reported, this study does not provide compelling evidence to change current practice away from using metformin first-line.
This review provides a thorough evaluation of the trial and highlights many issues raised by this trial that need further work, including those previously covered here. Additionally, this review highlighted weight gain as an adverse effect observed in the rosiglitazone group. At four years follow-up there was a difference of almost 7kg between patients taking rosiglitazone compared to those taking metformin. Some of this weight gain may be due to fluid retention but in already obese individuals this is still a cause for concern.
This review also concludes that metformin remains first-line based especially after consideration of cost. At the maximum doses used in the trial rosiglitazone would cost £49.48 per month compared to metformin at £3.60.
Action: Metformin continues to be the first-line hypoglycaemic for type 2 diabetes.