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Senior Citizen Health & Medicine
Diabetes Drug Glucophage Less Likely to Cause Weight
Gain and Reduces Bad Cholesterol
New research finds type 2 drugs about the same in
reducing blood glucose
July 17, 2007 – New research says most of the oral
medications for type 2 diabetes are about equal in reducing blood
glucose, but one, the drug Glucophage (metrormin), has interesting
advantages – it is less likely to cause weight gain and may be more
likely than other treatments to decrease "bad cholesterol", according to
a report funded by HHS’ Agency for Healthcare Research and Quality.
A version of the analysis was posted yesterday in
the on-line version of Annals of Internal Medicine.
The federally funded analysis is based on
scientific evidence found in 216 published studies. The report
summarizes the effectiveness, risks, and estimated costs for 10 drugs:
acarbose (sold as Precose), glimepiride (Amaryl), glipizide (Glucotrol),
glyburide (Micronase, DiaBeta, Glynase PresTab), metformin (Glucophage,
Riomet, Fortamet), miglitol (Glyset), nateglinide (Starlix),
pioglitazone (Actos), repaglinide (Prandin), and rosiglitazone (Avandia).
Type 2 diabetes is an increasingly common chronic
disease that occurs in people who have difficulty converting glucose (a
sugar) into energy. Blood glucose levels are high either because their
cells are resistant to insulin (a hormone that helps convert glucose
into energy) or because their pancreas does not produce enough insulin.
Diabetes can cause severe problems with the heart,
eyes, kidneys, and nerves. Obesity increases the risks of developing
type 2 diabetes. From 1980 through 2005, the number of Americans
diagnosed with diabetes soared from 5.6 million to 15.8 million.
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Older, Less-Costly Diabetes Drugs as
Effective as Newer Treatments, According to Study
Older, less-expensive
diabetes drugs are equally as effective and safe as newer,
costlier drugs, according to a study published online Monday
in the Annals of Internal Medicine, the
AP/Houston Chronicle
reports. For the first in-depth comparison of oral diabetes
drugs that have been released in the past decade and those
that have been available for decades, researchers led by
Shari Bolen of
Johns Hopkins University
reviewed more than 200 published studies and unpublished
information from drug companies and
FDA.
Metformin -- sold as Glucophage and generically for about
$100 per year -- "was the clear winner," according to the
AP/Chronicle. The inexpensive drug was found to
work just as well as other medications and does not cause
weight gain or dangerously low blood sugar levels. Metformin
also lowers LDL, or "bad," cholesterol levels.
Consumer Reports published a guide to the results,
which rated metformin, as well as glipizide and glimepiride
-- sold respectively as Amaryl and Glucotrol -- as "best
bets," the AP/Chronicle reports.
The study found that most oral diabetes medications reduce
A1c levels, an important measure of high blood sugar, by
about one percentage point. Bolen said that despite intense
marketing for newer drugs -- which can cost up to $262 per
month -- researchers "didn't find any benefit" to taking
them unless a patient was unable to tolerate an older drug.
The study was commissioned in May 2005 by the federal
Agency for Healthcare Research and Quality,
before a study released this year tied the
GlaxoSmithKline
diabetes drug Avandia to cardiovascular risks. The Hopkins
researchers said that evidence is insufficient to address
the Avandia issue (Marchione, AP/Houston Chronicle,
7/17).
>> The study is available
online.
>> The Consumer Reports guide also can be found
online.
Broadcast Coverage
ABC's "World
News" on Monday reported on the
study. The segment includes comments from Gail Shearer,
director of health policy analysis at
Consumers Union;
Sidney Wolfe, director of the
Health Research Group
at Public Citizen; and Alan Goldhammer, a vice president of
regulatory affairs at the
Pharmaceutical Research and Manufacturers of
America (Stark, "World News," ABC,
7/16).
>> A video excerpt of the segment is available
online.
Note: Reprinted with permission
from
kaisernetwork.org You can view the entire
Kaiser Daily Health Policy Report, search the archives, and sign up
for email delivery at
www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser
Daily Health Policy Report is published for
kaisernetwork.org, a free service of The Henry J. Kaiser Family
Foundation. © 2006 Advisory Board Company and Kaiser Family Foundation.
All rights reserved.
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“As more people are diagnosed with type 2 diabetes
and with the growing array of treatment choices, this is a landmark
review,’’ said AHRQ Director Carolyn M. Clancy, M.D.
“This summary of scientific evidence is not only an
important tool for clinicians and patients seeking the most appropriate
therapy, but it also points out in what areas we need more research to
confront this disease.”
As new classes of oral diabetes medications have
become available, patients and clinicians have faced a growing list of
treatment options. Earlier scientific reviews have highlighted some
differences between medications, but AHRQ’s new analysis is the first to
summarize evidence on the effectiveness and adverse events for all
approved oral medications commonly used in the United States for type 2
diabetes.
Diabetes patients typically are monitored with
tests that check the percentage of hemoglobin A1c (HbA1c) in their
blood. Checking for HbA1c is a more reliable indicator of chronic high
blood sugar than checking blood glucose itself. According to the AHRQ
review, most diabetes drugs offer about a one point absolute reduction
in HbA1c. In those cases, for example, a diabetes patient’s HbA1c might
drop from 8 to 7 (with 5 being normal in patients who don’t have
diabetes).
Nateglinide, acarbose, and miglitol lower HbA1c by
about half that much. Combining diabetes medications, evidence shows,
often works better at reducing HbA1c.
AHRQ’s analysis of published studies, completed by
the Agency’s Johns Hopkins University Evidence-based Practice Center in
Baltimore, also concluded:
● Metformin and acarbose do not increase weight
among diabetes patients. Other diabetes drugs (glimepiride, glipizide,
glyburide, pioglitazone, repaglinide, and rosiglitazone) have been shown
to increase weight by an average of 2 pounds to 11 pounds.
● Blood levels of low-density lipoprotein, which
is known as “bad cholesterol” because it may amplify risks of heart
attack and stroke, consistently decrease (by about 10 milligrams per
deciliter) in patients taking metformin and increase (by similar
amounts) in patients taking rosiglitazone and pioglitazone.
● Pioglitazone and rosiglitazone cause a small
but significant increase in high-density lipoprotein, often called “good
cholesterol” because it promotes the breakdown and removal of
cholesterol from the body.
● Glimepiride, glipizide, glyburide, and
repaglinide are associated with hypoglycemia (when blood glucose levels
go too low) more than other diabetes drugs.
● Metformin and acarbose are generally more
likely than other diabetes medications to cause gastrointestinal
problems such as diarrhea. Patients who used metformin alone were more
likely to experience problems than those using the drug at a lower dose
in combination with glimepiride, glipizide, glyburide, pioglitazone, or
rosiglitazone.
● Patients who take pioglitazone and
rosiglitazone have a greater risk of congestive heart failure compared
with those who take metformin, glimepiride, glipizide, or glyburide.
While one recent analysis raised the possibility that rosiglitazone may
also increase heart attack risks, authors of the AHRQ analysis concluded
that current evidence is not sufficient to make a meaningful assessment.
● More, longer studies are needed to understand
the impact of oral diabetes drugs on patients’ quality of life and
whether long-term use causes adverse side effects or reduces important
complications of diabetes such as heart disease and kidney disease.
Additional research is needed to study interactions between the drugs
and to compare therapeutic combinations of the drugs, according to the
report.
The report released today, Comparative
Effectiveness and Safety of Oral Diabetes Medications for Adults with
Type 2 Diabetes, is the newest analysis from AHRQ's Effective Health
Care program, authorized by the Medicare Prescription Drug, Improvement
and Modernization Act. That program represents an important federal
effort to compare alternative treatments for health conditions and make
the findings public. The program is intended to help patients, doctors,
nurses, and others choose the most effective treatments. Information can
be found at
http://www.effectivehealthcare.ahrq.gov.
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