July 16, 2007 / 9:28 PM / in 12 years

Older and cheaper pills just fine for diabetes

WASHINGTON (Reuters) - Older and cheaper pills are just as effective for treating diabetes as some of the more expensive new drugs, U.S. researchers reported on Monday.

A comparison of 10 diabetes drugs showed they all worked well to reduce levels of glucose, or sugar, in the blood. But each one has drawbacks, the federally funded researchers found.

The review, published in the Annals of Internal Medicine, will add to a growing debate about the safety of some of the newer diabetes drugs.

Used alone, metformin, the glitazones and newer sulfonylureas all reduced blood sugar about as well over time, Dr. Shari Bolen of Johns Hopkins University in Baltimore and colleagues found.

One thing they did not find — any evidence to support a contentious report that suggested one of the newer drugs, GlaxoSmithKline Plc’s Avandia, might raise the risk of heart attacks.

“Likewise, we found no statistically significant differences between specific oral diabetes medications in terms of cardiovascular outcomes other than congestive heart failure,” they wrote.

Gail Shearer of Consumer Reports said, “This is truly significant information for the millions of people with diabetes struggling to control their disease, but also struggling with the high cost of their medications.”


The study, funded by the U.S. government’s Agency for Healthcare Research and Quality, looked at 10 drugs: acarbose, sold as Precose or Glucobay; glimepiride or Amaryl; glipizide or Glucotrol; glyburide; metformin, sold under the names Glucophage, Riomet and Fortamet; miglitol or Glyset; nateglinide or Starlix; pioglitazone or Actos; repaglinide or Prandin; and rosiglitazone or Avandia.

Diabetes, which affects 194 million people worldwide, is the sixth-leading cause of death in the United States. Type 2 diabetes, linked with poor diet and a lack of exercise but which also has genetic causes, is by far the most common type.

Diet and exercise are the first line of treatment and prevention but most patients eventually need to take drugs, too, and usually a cocktail of them.

“As more people are diagnosed with type 2 diabetes and with the growing array of treatment choices, this is a landmark review,” AHRQ Director Dr. Carolyn Clancy said in a statement.

The researchers read through 216 published studies and systematic reviews for their report.

“Most agents other than metformin increased body weight by 1 to 5 kg (2 pounds to 12 pounds)” they wrote.

Metformin, one of the oldest and cheapest diabetes drugs, lowers low-density lipoprotein, or “bad cholesterol,” while the newer drugs Avandia and Actos, sold by Japan’s Takeda Pharmaceutical Co., raise LDL, they found.

But Avandia and Actos both raise high-density lipoprotein, often called “good cholesterol.”

Glimepiride, glipizide, glyburide, and repaglinide can bring blood sugar too low, the researchers found, while metformin and acarbose are generally more likely than other drugs to cause gastrointestinal problems such as diarrhea.

The report is available on the Internet at www.effectivehealthcare.ahrq.gov/reports/final.cfm.

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