MONTREAL -- New data presented at the 20th World Diabetes Congress of the International Diabetes Federation (IDF) compared two strategies for the initiation of treatment for patients with type 2 diabetes.

In the first phase (18 weeks), the treatment effects of Janumet (a fixed-dose combination of sitagliptin and metformin) and metformin as initial therapy were compared. In the second phase (26 weeks), the treatment strategies of initiating sitagliptin/metformin versus initiating metformin were compared (investigators used their clinical discretion, based upon glucose and HbA1c values, to add other diabetes treatments when necessary to achieve blood sugar control). At the end of this 44-week study, mean HbA1c reductions were consistent with those observed at week 18 (-2.4 percent Janumet vs - 1.8 percent metformin), the primary end point.

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Patients initially treated with sitagliptin/metformin achieved greater mean HbA1c reductions at 44 weeks compared with those initially treated with metformin (-2.3 percent vs -1.8 percent) even after physicians were encouraged to add other therapies to help patients achieve target blood sugar goals.

Metformin is the initial medication given to most newly diagnosed patients with type 2 diabetes with HbA1c < 9.0 percent. However, in patients with marked hyperglycemia (in particular those with bA1c greater than or equal to 9.0 percent, which is what this study included), the Canadian Diabetes Guidelines recommend antihyperglycemic agents should be initiated concomitantly with lifestyle management, and consideration should be given to initiating combination therapy with two agents or imitating insulin treatment in symptomatic individuals.

The management options recommended in the guidelines of the Canadian Diabetes Association can be used at the physician's discretion.

"Close to half of current type 2 diabetes patients have not achieved adequate blood sugar control," said Barry J. Goldstein, MD, PhD, vice president of Clinical Research, Diabetes and Obesity, Merck & Co., Inc. "The significance of this study is that those starting treatment with Janumet achieved greater HbA1c reductions after 44 weeks compared with those starting treatment with metformin. These findings support the initial use of combination therapy for appropriate patients at diagnosis with type 2 diabetes."