Should Newer Agents Replace Metformin as First-Line Drugs for Type 2 Diabetes?

Although most guidelines recommend metformin as the first-line agent for patients with type 2 diabetes (Diabetes Care 2018; 41:2669), some experts now advocate starting with newer agents (e.g., sodium–glucose cotransporter-2 [SGLT-2] inhibitors and glucagon-like peptide-1 [GLP-1] receptor agonists) as first-line therapy. In a cost-effectiveness analysis, researchers used randomized, controlled trials and large patient databases to estimate life expectancy and cost differences if patients with new diabetes used SGLT-2 inhibitors or GLP-1 receptor agonists as first-line agents instead of metformin.

First-line SGLT-2 inhibitors or GLP-1 receptor agonists were associated with ≈5% fewer macrovascular complications (i.e., heart failure, ischemic h…