Europe and the US have different judgments on primary treatment for ASCVD patients
Metformin, which has been an essential option for diabetes treatments for decades, is at the heart of debates because a full-fledged discussion of whether Metformin should still be recommended as a first-line treatment for patients with established arteriosclerotic cardiovascular disease (ASCVD) or high-risk groups was notified.
The American Diabetes Association (ADA) announced on the 9th (local time) that they will hold an expert discussion on whether to recommend Metformin as the primary treatment for ASCVD patients or high-risk groups before the 80th-anniversary online conference which will open on the 12th.
Metformin has established itself as a steadfast first-line treatment over the past six decades with various advantages such as accumulated experience, strong hypoglycemic effect, as well as low drug prices.
However, new drugs are emerging to challenge Metformin and reduce not only the hypoglycemic effect but also complications of cardiovascular disease.
Although there is a controversial data in patients whose risk of cardiovascular disease is low, undeniable data is coming out to prevent secondary victims in patients who had the cardiovascular disease before.
Among the GLP-1 analogs, liraglutide (product name as Victoza, Novo Nordisk) proved the effectiveness of cardiovascular disease prevention through LEADER research and semaglutide (product name as Ozempic, Novo Nordisk) and dulaglutide (product name as Trulicity, Lilly) through SUSTAIN-6 and REWIND.
Besides, among SGLT-2 inhibitors, empagliflozin (product name as Jardiance, Boehringer Ingelheim) has also confirmed effectiveness from cardiovascular disease through EMPA-REG, and canagliflozin (product name as Invokana, Janssen) and dapagliflozin (product name as Forxiga, AstraZeneca) through CANVAS and DECLARE research.
Therefore, last year, the European Association for the Study of Diabetes (EASD) suggested taking SGLT-2 inhibitors or GLP-1 analogs to patients with cardiovascular disease or high-risk group before Metformin, and it shook the position of Metformin in the market.
Moreover, at the end of last year, NDMA, which is classified as a carcinogen, was found from the Metformin in Singapore.
Recently, the Ministry of Food and Drug Safety has suspended the sales of some of the Metformin drugs in South Korea.
In this regard, the Korean Diabetes Association said that Metformin is still an important drug recommended by domestic and foreign academics as the first-line medicine for type 2 diabetes patients but suggested further changes on coverage decisions to the characteristics of patients.
In the meantime, Professor Francesco Cosentino of the Stockholm Karolinska Institute in Sweden, with EASD’s recommendation, plans to present about Metformin can no longer be the first-line treatment for patients with ASCVD or high-risk patients with ASCVD at the ADA debate forum on the 14th.
On the other hand, Professor Melanie Davies of Leicester University in England will support the ADA, which still proposes Metformin as the first treatment.
It is worth noting whether this forum will rush the end of the Metformin era or once again reaffirm its steady position.
