MONDAY, March 14 (HealthDay News) -- Although there are numerous
options in oral medications for type 2 diabetes, an older drug --
metformin -- may be the best first-line option, according to a new
analysis of research on diabetes medications.
The analysis included six classes of oral diabetes medications,
and found that all of them lower blood sugar levels by a similar
amount. The authors suggest that metformin is probably the best
first-line choice because it has fewer side effects than other
drugs and, because it's an older medication and available in a
generic form, it also costs less.
"Metformin continues to be an inexpensive medication and it's very efficacious," said the study's lead author, Dr. Wendy Bennett, an assistant professor of medicine at Johns Hopkins University School of Medicine in Baltimore.
Nearly 26 million Americans have diabetes, according to the U.S.
Centers for Disease Control and Prevention. Untreated, diabetes can
lead to numerous complications, including kidney disease, eye
disease, heart problems and amputations.
There are 11 classes of diabetes medications that are approved
to treat high blood sugar in people with type 2 diabetes in the
United States. Nine of these classes of medications have been
available since 1995, according to background information in the
study, which was led by researchers at Johns Hopkins University,
along with researchers at Case Western Reserve University in
Cleveland, Ohio, and the University of North Carolina at Chapel
Most people with type 2 diabetes need to take more than one
medication to adequately control their blood sugar levels, the
study authors noted.
The most common serious side effect from any of these blood
sugar-lowering medications is hypoglycemia, or low blood sugar
levels. Other common side effects include gastrointestinal
problems, such as nausea or diarrhea. Bennett said that these side
effects can be minimized by starting with a lower dose of
medication initially and taking it with a meal.
The researchers, who were supported by the U.S. Agency for
Healthcare Research and Quality, reviewed a total of 166 studies
for the current analysis. The studies included six classes of
medication: metformin (Glucophage, Fortamet and others);
sulfonylureas (Amaryl, Glucotrol and others); thiazolidinediones
(Avandia and Actos); meglitinides (Starlix and Prandin); DPP-4
inhibitors (Januvia and Onglyza); and GLP-1 receptor agonists
(Byetta and Victoza).
In general, most of the medications lowered hemoglobin A1C
levels (a measure of long-term blood sugar control) by one
percentage point. The American Diabetes Association recommends that
most people with diabetes keep their A1C levels below 7 percent, so
a drop of one percentage point is clinically meaningful.
The researchers also found that adding a second medication
improves blood sugar control, but that no combination of
medications appeared to offer significant benefits over
Metformin, which was associated with an increased risk of
diarrhea, appeared to have the lowest side-effect profile,
according to the analysis. And, it also cost the least, according
to the report. Metformin costs about $0.35 per pill compared to
$6.42 for Januvia, according to the study authors.
As a class of medications, thiazolidinediones, which include
Actos and Avandia, have come under intense scrutiny because of
serious potential side effects, and this analysis confirmed that
weight gain, fractures and an increased risk of congestive heart
failure are associated with thiazolidinediones. Although heart
attacks have also been linked to the class of medications, this
analysis was not able to confirm or refute an increased risk of
heart attack, according to Bennett.
Sulfonylureas and meglitinides were associated with an increased
risk of hypoglycemia, the study noted.
The study, which reviewed 140 randomized controlled trials and
26 observational studies, noted that 95 reported pharmaceutical
company support. In addition, most lasted no more than two years
and generally excluded people with type 1 diabetes, those with
serious co-existing conditions and those of older age.
Results of the study are published in the March 15 issue of the
Annals of Internal Medicine.
Dr. Joel Zonszein, director of the Clinical Diabetes Center at
Montefiore Medical Center in New York City, said this study doesn't
offer much new information.
"As is well known, most medications lowered A1C similarly. The question is what medication to use in what patient population? A one-size-fits-all approach is the wrong approach," said Zonszein.
"There is tremendous patient variability. Some people have a great response [to certain medications], some have none. What we need are studies sponsored by the National Institutes of Health, not pharmaceutical companies, so that we can learn better how to use these drugs in combination," he added.
Learn more about the different types of oral diabetes
medications from the
American Diabetes Association.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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