Metformin Is Still Tops for Diabetes, Says Study Review


By: Linda von Wartburg

That old standby, metformin, is still your best bet. In fact, thereis no benefit in taking the newer oral medications unless you can'ttolerate the older ones.

That was the conclusion of researchers from Johns HopkinsUniversity who examined 216 controlled studies and two systematicreviews in order to compare older oral medicines (second-generationsulfonylureas and metformin) and newer medications(thiazolidinediones, meglitinides, and alpha-glucosidase inhibitors)with regard to medium-term effects on A1c levels, lipid levels, bodyweight, and adverse outcomes.

Overall, the researchers found metformin to have the best benefit torisk ratio. Metformin was similar to or even better than the otheroral medicines with regard to blood sugar control and lipid levels,though it was associated with greater risk of gastrointestinalproblems.

In addition, it did not cause the 2.2 to eleven pound weight gainassociated with almost all the other medicines. Second-generationsulfonylureas did pretty well too, apart from a greater risk ofhypoglycemia.

Compared with newer agents, both metformin and sulfonylureas hadthree distinct advantages: longer use in practice, more informationabout longer-term effects, and lower cost. Metformin is availablegenerically for about $40 monthly, for example, while Avandia cancost over $250 monthly.

Thiazolidinediones (like Actos and Avandia) were found to have alower risk for hypoglycemia and a small beneficial effect on healthycholesterol (HDL) levels, but were no better at lowering bloodglucose and were also associated with adverse effects on badcholesterol (LDL), weight, and risk of congestive heart failure.

(The researchers noted that large, longer-term comparativestudies are still needed on outcomes such as myocardial infarction,chronic kidney disease, and cardiovascular mortality, as this reviewfocused only on medium-term effects.)

The study review, which was commissioned in May 2005 by the federalAgency for Healthcare Research and Quality, has been used by Consumer Reports as the basis for its "best buy" evaluations of oral diabetes medications. In sum, Consumer Reports concluded that newerdrugs are no better, no safer, and certainly more expensive.

Sources: Annals of Internal Medicine, September 2007
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