Efficacy of metformin on glycemic control and weight in drug-naive type 2 diabetes mellitus patients: A systematic review and meta-analysis of placebo-controlled randomized trials

Carole Piera-Mardemootoo (1) , Philippe Lambert (1) , Jean-Luc Faillie (2, 3)

1 UM - Université de Montpellier
2 AIDMP - Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415
3 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]

AIM OF THE STUDY: Metformin is recommended as the first-line treatment of type 2 diabetes mellitus. Despite its common use, few studies have been conducted to precisely measure the efficacy of metformin versus placebo as a first-line treatment. This study aims to assess the precise effects of metformin monotherapy on glycemic control and weight in drug-naive patients with type 2 diabetes mellitus. METHODS: Medline\textregistered and Cochrane databases were searched until March 19, 2016 to perform a systematic review and meta-analysis of placebo-controlled randomized trials evaluating metformin monotherapy in drug-naive patients with type 2 diabetes mellitus. Assessed outcomes include glycemic control (fasting plasma glucose, glycosated hemoglobin) and weight. RESULTS: Overall, 16~studies (1140~patients) were selected. Compared to placebo, metformin monotherapy was associated with decreased glycosated hemoglobin by 0.95% at 3~months (95% CI: 0.50 to 1.39, I2=87%) and 1.32% at 6~months (95% CI: 1.01 to 1.62, I2=71%), and decreased fasting plasma glucose by 1.92mmol/L at 1 month (95% CI: 0.11 to 3.74, I2=88%), 1.79mmol/L at 3~months (95% CI: 0.92 to 2.66, I2=88%) and 2.14mmol/L at 6~months (95% CI: 1.17 to 3.12, I2=82%). No significant difference was demonstrated for the comparisons of weight due to relatively small number of studies retrieved from the literature resulting in insufficient statistical power. CONCLUSION: This study provides the precise effects of metformin monotherapy regarding the decreases in fasting plasma glucose and glycosated hemoglobin that physician can expected in drug-naive patients with type 2~diabetes mellitus. No evidence was found for the effects on weight.

Mots clés: Type 2 diabetes mellitus; Metformin; Randomized controlled trials; Meta-analysis

Domaines: Endocrinologie et métabolisme; Pharmacologie

Carole Piera-Mardemootoo, Philippe Lambert, Jean-Luc Faillie. Efficacy of metformin on glycemic control and weight in drug-naive type 2 diabetes mellitus patients: A systematic review and meta-analysis of placebo-controlled randomized trials. Thérapie, 2021, 76 (6), pp.647-656. ⟨10.1016/j.therap.2018.01.006⟩. ⟨hal-02341129⟩