Metformin dose up-titration and glycemic control in type 2 diabetes in a resource-limited setting, northern Ethiopia:...

Metformin is the preferred initial therapy for type 2 diabetes mellitus (T2DM) and gradual upward dose titration is recommended to reach target blood glucose levels. The aim of this study was to assess the pattern of metformin dose up-titration and its effect on glycemic control among T2DM patients.

A retrospective cohort study of people with T2DM was conducted at Ayder Comprehensive Specialized Hospital from January to March 2020. Participants with fasting plasma glucose above 140 mg/dl after one month of initiating metformin were followed over the course of treatment. Multivariable binary logistic regression models were used to evaluate independent variables associated with metformin dose up-titration and glycemic control. The output of the logistic regression was expressed as adjusted odds ratios at 95% confidence intervals. Test results were considered statistically significant when p < 0.05. A total of 284 T2DM patients on metformin were included in the study.

The mean age and SD of the study participants was 54.0 ± 10.5. Metformin dose was up-titrated at least once in 61.6% of the study participants. Almost half of the study participants had achieved glycemic control (HbA1c ≤ 7). Having a duration of treatment less than five years, initiating metformin at a daily dose of 500 mg and the addition of hypoglycemic medications were independent predictors of metformin dose up-titration. T2DM patients whose metformin dose was up-titrated had two times higher odds of having controlled blood glucose levels compared to those not up-titrated (P-value: 0.015; OR: 1.823; 95% CI: 1.121-2.963). A gradual metformin dose titration at later than the 4th month was associated with better glycemic control. T2DM patients whose metformin dose was titrated only once were less likely to achieve glycemic control (P-value: 0.038; OR: 0.482; 95% CI: 0.242-0.962).

In this resource-constrained setting, metformin dose up-titration was less commonly practiced than adding another hypoglycemic agent in the management of T2DM. However, dose up-titration was associated with a higher likelihood of achieving glycemic control. These findings suggest that optimizing metformin dosing may improve glycemic outcomes before intensifying therapy with additional agents, although prospective studies are needed to confirm this association.

Not applicable.