GLP-1 RAs Superior to Metformin for Blood Sugar Control, Yet Metformin Shows Higher Adherence in Prediabetes: Study

The main outcomes analyzed included the one-year risk of requiring additional glucose-lowering medications and the one-year risk of non-adherence. One-year risks were estimated using multiple logistic regression and standardized methods, while multiple linear regression was applied to assess average differences in changes to biomarkers.

Based on the study, the researchers reported the following findings:

• The study included 1,778 individuals initiating treatment with GLP-1 receptor agonists or metformin.
• After adjusting for various factors, GLP-1 RA was linked to a lower one-year risk of requiring additional glucose-lowering treatment in patients with prediabetes (one-year risk ratio [RR]: 0.27) and diabetes (RR: 0.67).
• Among patients with prediabetes, GLP-1 RA was associated with a higher one-year risk of nonadherence (RR: 1.60), while there was no significant difference in patients with diabetes (RR: 0.88).
• Compared to metformin, GLP-1 RA was associated with greater reductions in HbA1c levels, with a decrease of −2.59 mmol/mol for prediabetes and −3.79 mmol/mol for diabetes.

The findings indicated that in patients with prediabetes, starting treatment with GLP-1 receptor agonists was linked to a reduced risk of needing additional glucose-lowering therapy compared to metformin. However, those initiating metformin demonstrated significantly higher levels of adherence.

"In patients with diabetes, GLP-1 RA initiation similarly resulted in a lower risk of requiring extra glucose-lowering therapy, but there was no difference in nonadherence rates when compared to metformin initiation," the researchers wrote.

Reference:

Sørensen, K. K., Gerds, T. A., Køber, L., Fosbøl, E. L., Poulsen, H. E., Møller, A. L., Andersen, M. P., Pedersen-Bjergaard, U., Torp-Pedersen, C., & Zareini, B. (2024). Comparing Glucagon-like peptide-1 receptor agonists versus metformin in drug-naive patients: A nationwide cohort study. Journal of Diabetes, 16(10), e70000. https://doi.org/10.1111/1753-0407.70000