Evidence map›Paper›PMID 32868349›Full record

Observational studyBMJ open2020

Metformin discontinuation in patients beginning second-line glucose-lowering therapy: results from the global observational DISCOVER study programme.

Kamlesh Khunti, Marilia B Gomes, Mikhail Kosiborod, Antonio Nicolucci, Stuart Pocock, Wolfgang Rathmann, Marina V Shestakova, Iichiro Shimomura, Hirotaka Watada, Hungta Chen and 6 more

2 registry-linked trialsAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02226822 completednot on this map

J-DISCOVER: DISCOVERing Treatment Reality of Type 2 Diabetes in Real World Setting in Japan

TypeobservationalSponsorAstraZenecaRan2014 to 2019Enrolled1,869ConditionsType 2 Diabetes Mellitus
NCT02322762 completednot on this map

DISCOVERing Treatment Reality of Type 2 Diabetes in Real World Settings

TypeobservationalSponsorAstraZenecaRan2014 to 2019Enrolled15,992ConditionsType 2 Diabetes Mellitus
3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Use of Animal Models for Investigating Cardioprotective Roles of SGLT2 Inhibitors.Journal of cardiovascular translational research · 2023
    Review
  5. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Kamlesh KhuntiDiabetes Research Centre, University of Leicester, Leicester, UK kk22@le.ac.uk.ORCID 0000-0003-2343-7099
Marilia B GomesDepartment of Internal Medicine, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.
Mikhail KosiborodDepartment of Cardiovascular research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.
Antonio NicolucciDepartment of Metabolic Medicine, Center for Outcomes Research and clinical Epidemiology (CORE), Pescara, Italy.
Stuart PocockDepartment of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
Wolfgang RathmannInstitute for Biometrics and Epidemiology, German Diabetes Center, Düsseldorf, Germany.
Marina V ShestakovaFeberal Scientific Centre of Endocrinology, Endocrinology Research Centre, Moscow, Russian Federation.
Iichiro ShimomuraDepartment of Metabolic Medicine, Osaka University Hospital, Suita, Osaka, Japan.
Hirotaka WatadaDepartment of Metabolism and Endocrinology, Juntendo University, Bunkyo-ku, Tokyo, Japan.
Hungta ChenAstraZeneca, Gaithersburg, Maryland, USA.
Javier Cid-RuzafaEvidera, Barcelona, Spain.
Peter FeniciAstraZeneca, Cambridge, UK.
Niklas HammarInstitute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Fengming TangDepartment of Cardiovascular research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.
Linong JiDepartment of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
DISCOVER Scientific Committee and all DISCOVER investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo evaluate the extent to which patients with type 2 diabetes discontinue metformin therapy when initiating second-line treatment and factors associated with metformin discontinuation, using baseline data from the DISCOVER study programme.

designDISCOVER is a 3-year, prospective, observational study programme including data from 38 countries across 6 continents from 2014 to 2019.

settingPrimary and secondary healthcare centres, hospitals and specialist diabetes centres in both urban and rural locations.

participantsA total of 15 992 patients with type 2 diabetes initiating second-line glucose-lowering therapy. PRIMARY AND SECONDARY OUTCOME MEASURES: The proportion of patients who discontinued metformin as a second-line therapy and the factors associated with this treatment change.

resultsOf the 14 668 patients (from 37 countries) with valid treatment data, 11 837 (80.7%) received metformin as first-line glucose-lowering therapy; 8488 (71.7%) received metformin monotherapy and 3349 (28.3%) received metformin as part of a combination therapy. Overall, treatment with metformin was discontinued in 15.1% (1782) of patients who received first-line metformin (14.1% (1194) and 17.6% (588) in those who received metformin as monotherapy and as part of a combination, respectively); this proportion varied across regions from 6.9% (54) in Africa to 20.6% (628) in South-East Asia. On metformin discontinuation, 73.6% (1311) of patients received a non-insulin monotherapy at second line. Factors associated with an increased odds of metformin discontinuation were older age (≥75 years) and having a history of chronic kidney disease. The probability of metformin monotherapy discontinuation was lower in patients from Africa than in those from Europe.

conclusionsA substantial number of patients discontinued taking metformin when beginning second-line therapy. Most of these patients subsequently received a non-insulin monotherapy at second line, in contradiction to international guidelines and potentially leaving them at an increased risk of hyperglycaemia and associated adverse outcomes. TRIAL REGISTRATION NUMBERS: NCT02322762 and NCT02226822.

Indexed as

AgedDiabetes Mellitus, Type 2Drug DiscoveryDrug SubstitutionGlobal HealthGuideline AdherenceHumansHypoglycemic AgentsMaleMetforminMiddle AgedPractice Patterns, Physicians'Prospective StudiesHypoglycemic AgentsMetformindiabetes & endocrinologyepidemiologygeneral diabetes

Identifiers

PMID32868349
PMCPMC7462233

What OpenQuestion holds

Texttitle and abstract
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.