Older Diabetes Drug Sometimes the Best Choice

Metformin doesn't cause weight gain and can decrease 'bad' cholesterol, study finds

MONDAY, July 16, 2007 (HealthDay News) -- A new U.S. report says an older drug for treating the most common form of diabetes is better in many cases than a new generation of medications.

The report doesn't recommend that doctors abandon prescribing the new drugs for type 2 diabetes, because they may be appropriate in some instances. But the report does give a boost to the 12-year-old drug metformin, sold generically under a variety of brand names.

"The newer drugs are not necessarily better than the older, less expensive drugs," said Jean Slutsky, director of the Agency for Healthcare Research and Quality's Center for Outcomes and Evidence, which commissioned the report. She added that metformin doesn't cause weight gain and actually decreases "bad" cholesterol levels.

Type 2 diabetes, which is reaching epidemic proportions in the United States, occurs in people who have trouble converting blood glucose into energy for cells. Obesity increases the risks for the disease, with the number of Americans diagnosed climbing from 5.6 million in 1980 to an estimated 16 million today. Diabetes can cause severe problems with the heart, eyes, kidneys, and nerves.

There are large numbers of medication options for doctors to consider, including metformin, which has been available in the United States since appearing under the brand name Glucophage in the mid-1990s. It's one of the most popular drugs in the world.

There are also newer, more expensive drugs like thiazolidinediones (including Avandia and Actos) and meglitinides (Prandin). Avandia has been in the news recently because of reports linking it to a higher risk of heart attack.

In the new report, researchers examined previous studies about the various diabetes drugs. The report was published online Monday and is expected to be in the Sept. 18 print edition of the Annals of Internal Medicine.

The report touts metformin and says thiazolidinediones and second-generation sulfonylureas produced the most serious side effects, including congestive heart failure and severe hypoglycemia -- low blood sugar. Another drug, repaglinide, was linked to less-serious forms of hypoglycemia in the elderly and people who skip meals.

Slutsky said the newer drugs are sometimes a good choice. While it has benefits, metformin is more likely to cause stomach problems such as diarrhea, she said.

Dr. Larry Deeb, the American Diabetes Association's president of medicine and science, said the report doesn't break much new ground in its contention that the older drugs still work well. "I think people knew that forever," he said, noting that his association recommends metformin as the first drug of choice.

Still, Deeb suspects that some doctors are so concerned about low blood sugar that they use newer drugs instead of insulin or the older drugs because of concerns about hypoglycemia. "Learning how to use [insulin] and not provoking hypoglycemia is something that I would hope primary doctors would learn how to do," he said.

Slutsky said the new report is important because "there are almost a dozen drugs to control glucose in type 2 diabetics, and it would be very hard for an individual physician to go through the literature for each drug."

For patients, the report's message is that it's important to ask your doctor about the safest drug for you, she said.

More information

Learn more about diabetes drugs from the U.S. Food and Drug Administration.

SOURCES: Jean Slutsky, director, Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, Rockville, Md.; Larry Deeb, M.D, president for medicine and science, American Diabetes Association, Tallahassee, Fla.; Sept. 18, 2007, Annals of Internal Medicine
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