Metformin as initial therapy is supported by a meta-analysis of 140 trials and 26 observational studies.
Older drugs (metformin and second generation sulfonylureas) had similar efficacy in reducing A1C values (1%) and other cardiovascular risk factors (blood pressure, lipids, body weight) compared with newer drugs (thiazolidinediones, meglitinides, and GLP-1 receptor agonists).
Source: Ann Intern Med 2011; 154:602.
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