stock photo

Oral medication is a common treatment option for patients with type 2 diabetes. A study at Johns Hopkins found that metformin which was approved by the FDA back in 1995 showed the most benefits compared to nine other, mostly newer drugs on the market for diabetes.

Metformin also sold as Glucophage, Riomet, and Fortamet was shown to be effective at controlling blood sugar levels and was less likely to cause weight gain and at the same time was more effective than the other medications at lowering bad cholesterol levels.

The benefits to taking medication to control blood glucose and cholesterol in type 2 diabetics are an important way to help slow down or even potentially prevent heart disease or other damage, such as blindness, and kidney failure.

“Sometimes newer is not necessarily better,” said lead study author Shari Bolen, M.D., an internist at Hopkins.

“Issues like blood sugar levels, weight gain and cost could be significant factors to many patients struggling to stay in good health,” explained Bolen, who is also an instructor at The Johns Hopkins University School of Medicine.

The study was conducted which compared the commonly prescribed oral medications used for lowering and controlling blood sugar levels. All of the drugs studied were reported as being equally safe, but metformin got the best review because it was just as effective at lowering glucose levels without lowering it too much and did so at a much lower cost.

Metformin lowered LDL “bad” cholesterol levels on average of 10 milligrams per deciliter of blood. The newer thiazolidinediones, such as piogliatazone (Actos) and rosigliatozone (Avandia) had the opposite effect on cholesterol levels and increased the “bad” cholesterol by the same amount.

Metformin does have some drawbacks which can include problems with digestion and diarrhea. There is also a potential side effect of potential buildup of lactic acid in the blood of people that have moderate kidney or heart disease, which in these cases metformin should not be prescribed.

Thiazolidinediones such as piogliatazone (Actos) and rosigliatozone (Avandia) did have the benefit of increasing the HDL “good” cholesterol levels a small amount. Another benefit found with thiazolidinediones was they had less occurrences of too-low blood sugar levels compared to glimepiride (Amaryl), glipizide (Glucotrol), glyburide (Micronase, DiabBeta, Glynase PresTab) -- known as second-generation sulfonylureas.

Cost is also a factor considered in this study for the prescription drugs with metformin or sulfonylureas costing an average of $100 annually where newer drugs such as the thiazolidinediones cost around $400 annually. They researchers do expect the cost of the newer thiazolidinediones to come down in cost once generic version become available.

“When you are dealing with an epidemic like diabetes, it is important for people to weigh their treatment options with their physician and to make informed decisions about which medication best suits their needs,” says Bolen.

Glimepiride, glipizide, and glyburide the researchers point out did the worst at having more frequent too-low blood sugar levels than the other drugs. Sulfonylureas and acarbose did not show to have any effect on bad cholesterol. Drug treatment caused an average weight gain of 2 to 11 pounds except in the cases of metformin and acarbose.

In the study, Bolen and her colleagues reviewed the scientific evidence from 216 previous studies and compared each drug for its clinical effectiveness, risks and costs. In addition to metformin, the thiazolidinediones and sulfonylureas, drugs included in their analysis were repaglinide (Prandin), miglitol (Glyset), acarbose (Precose), and nateglinide (Starlix).

The researchers found a very slight increase risk of heart failure taking thiazolidinediones that did not have a prior history of heart disease. They reported less than three people per one hundred. The researchers do not have sufficient information to verify if rosiglitazone (Avandia) causes and increase risk of heart attack.

The researchers intend to study to compare the long-term benefits of different drug treatments for type 2 diabetes and quality of life and life expectancy. The researchers also want to compare the injectible medication, especially insulin which was not studied at this time.

By Mark Barone
Best Syndication Writer