(HealthDay News) — Among patients with type 2 diabetes initiating antidiabetes drugs (ADDs), first-line use of metformin has increased since 2005, while sulfonylureas have remained the most popular second-line agent, according to a study published online in Diabetes Care.

Olga Montvida, from Queensland University of Technology in Australia, and colleagues used data from the US Centricity Electronic Medical Records to identify 1,023,340 patients with type 2 diabetes (aged 18 to 80 years) who initiated any ADD and 357,482 patients who initiated second-line ADD after first-line metformin.

The researchers found that between 2005 and 2016, first-line use of metformin increased from 60 to 77%, while first-line use of sulfonylureas decreased from 20% to 8%. Over a mean 3.4 years of follow-up, post-metformin, 48% initiated a second ADD at a mean HbA1c of 8.4%. Although sulfonylurea usage as a second-line treatment decreased (60 to 46%), it remained the most popular second ADD choice, while use increased for insulin (7 to 17%) and dipeptidyl peptidase-4 inhibitors (0.4 to 21%).

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“Most patients initiate second-line therapy at elevated HbA1c levels, with highly heterogeneous clinical characteristics across ADD classes,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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Montvida O, Shaw J, Atherton JJ, Stringer F, and Paul SK. Long-term Trends in Antidiabetes Drug Usage in the U.S.: Real-world Evidence in Patients Newly Diagnosed With Type 2 Diabetes. Diab Care; dc171414. doi: 10.2337/dc17-1414