Eerst metformine geven, dan pas nadenken over gewenste HbA-streefwaarde?

Relevant benefits on clinical endpoints by HbA_1c reduction are modest at best and demonstrated only after long-term follow-up for patients with type 2 diabetes mellitus (T2DM). When medications that are often prescribed for many years, even decades, are supported by randomized trials that only showed limited or delayed benefits, the burden and risks of adverse events become particularly important. We discuss a study that estimated the effects of HbA_1c reduction on diabetes-related outcomes and quality-adjusted life years in an observational setting using a Markov simulation model. The results showed that for most patients older than 50 years who have HbA_1c levels less than 9% and were receiving metformin mono-therapy, the addition of other glycaemic treatments offered modest benefits at best. Although patients were not randomized, the sample could be a fair representation of daily care. These results show that when treating patients with T2DM, therapies should be individualized and based on realistic estimates of expected benefits and they should be weighed against the patient's views of the burdens of treatment.

Conflict of interest and financial support: none declared.