Efficacy of Single Dose Extended Release Metformin versus Conventional Thrice Daily Metformin in Patients with Type 2 Diabetic Patients

Rida Al Sunnah; Ghulam Hussain Ibrahim; Elleyyeen Avais; Fawad Ahmed; Sana Abbas; Zara Aamir

doi:10.54112/bcsrj.v6i6.2369

Authors

Rida Al Sunnah Department of Medicine, Combined Military Hospital, Abbottabad, Pakistan
Ghulam Hussain Ibrahim Department of Medicine, Combined Military Hospital, Abbottabad, Pakistan
Elleyyeen Avais Department of Medicine, Combined Military Hospital, Abbottabad, Pakistan
Fawad Ahmed Department of Medicine, Pak Emirates Military Hospital, Rawalpindi, Pakistan
Sana Abbas Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan
Zara Aamir Department of Medicine, Pak Emirates Military Hospital, Rawalpindi, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i6.2369

Keywords:

Delayed-Action Preparations; Diabetes Mellitus, Type 2; Glycated Hemoglobin; Medication Adherence; Metformin

Abstract

Immediate-release metformin often requires multiple daily doses, which may reduce adherence and increase gastrointestinal intolerance. Extended-release formulations may offer comparable glycaemic control with a more convenient dosing schedule. Objective: To compare the glycaemic efficacy, medication adherence, and gastrointestinal tolerability of once-daily extended-release metformin with thrice-daily metformin in patients with type 2 diabetes mellitus. Methods: This randomized controlled trial was conducted in the Department of Medicine, Combined Military Hospital Abbottabad, from February to April 2025. A total of 120 patients aged 30–70 years with type 2 diabetes mellitus and baseline glycated haemoglobin levels of 7.0%–10.5% were enrolled through consecutive sampling and randomly allocated into two equal groups. Group A received extended-release metformin 2000 mg once daily, whereas Group B received immediate-release metformin 500 mg three times daily. Participants were followed for 24 weeks. Glycated haemoglobin, fasting blood glucose, postprandial blood glucose, medication adherence, and gastrointestinal adverse effects were assessed. Data were analysed using SPSS version 26.0. Continuous variables were compared using independent-samples and paired-samples t-tests, whereas categorical variables were compared using the chi-square test. A p-value <0.05 was considered statistically significant. Results: All 120 participants completed the study, with 60 patients in each group. Baseline demographic and clinical characteristics were comparable between the groups. Mean glycated haemoglobin decreased from 8.54±0.71% to 6.98±0.56% in the extended-release group and from 8.49±0.74% to 7.08±0.61% in the immediate-release group. The between-group difference was not statistically significant (p>0.05). Both groups also demonstrated comparable improvements in fasting and postprandial blood glucose levels. Medication adherence was significantly higher in the extended-release group than in the immediate-release group (90.0% vs 75.0%; p=0.03). Gastrointestinal adverse effects were less frequent among patients receiving extended-release metformin. Conclusion: Once-daily extended-release metformin provided glycaemic control comparable to thrice-daily immediate-release metformin while achieving better medication adherence and gastrointestinal tolerability. Extended-release metformin may therefore be a suitable alternative for patients requiring simplified long-term treatment.

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