Dose distribution and up‐titration patterns of metformin monotherapy in patients with type 2 diabetes

Aims: To assess the dose distribution among users of metformin monotherapy as well as the patterns of up-titration following initiation of therapy in people with type 2 diabetes mellitus (T2DM). Materials and Methods: This was a retrospective cohort study of adults with T2DM in the United Kingdom (UK). Metformin dose distribution was assessed at 0, 6 and 12 months in people initiating metformin monotherapy (new users) and cross-sectionally in people with ongoing metformin monotherapy (prevalent users). Patterns and predictors of up-titration were also analysed in new users. Dose distributions and treatment patterns were assessed descriptively; predictors of up-titration were determined using multivariable logistic regressions. Results: Totals of 6174 new users and 8733 prevalent users were included. New users initiated metformin at >0 mg to 500 mg to 1000 mg to 1500 mg to 0 mg to 500 mg to 1000 mg to 1500 mg to 2000 mg (1%) daily. Among new users of metformin, 6.7% and 10.8% had been up-titrated at 6 and 12 months, respectively, despite the majority having glycated haemoglobin >53 mmol/mol. Predictors of up-titration included younger age and higher HbA1c. Conclusions: A majority of T2DM patients taking metformin received a dose