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Senior Citizen Health & Medicine
Comparison of Top 10 Diabetes Drugs Finds Older is
Better
Metformin (Glucophage, Riomet and Fortamet) has
advantages
July 25, 2007 In the midst of the warnings and
confusion over drugs to treat diabetes, a major chronic illness for
senior citizens, a type 2 diabetes drug taken orally and in widespread
use for more than a decade has been found to have distinct advantages.
It was tested against nine other, mostly newer medications used to
control the chronic disease, in a study by researchers at Johns Hopkins.
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In their report, published online July 16 in the
journal Annals of Internal Medicine, the Hopkins team found that
metformin, first approved by the U.S. Food and Drug Administration in
1995 (and sold as Glucophage, Riomet and Fortamet), not only controlled
blood sugar levels but also was less likely to cause weight gain and
more likely than others to lower bad cholesterol levels in the blood.
Researchers say these health benefits are important
because they can potentially ward off heart disease and other
life-threatening consequence from diabetes. More than 15 million
Americans have type 2 diabetes.
Sometimes newer is not necessarily better, says
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, says Bolen,
an instructor at The Johns Hopkins University School of Medicine.
In what is believed to be the largest drug
comparison of its kind, the scientists showed that all of the commonly
used oral medications worked much the same at lowering and controlling
blood sugar levels, and were equally safe.
But metformin stood out because it offered the same
level of effectiveness without lowering glucose measurements too much,
and it did so for a lower price.
Metformin was found to lower LDL or bad cholesterol
by about 10 milligrams per deciliter of blood, while newer medications
studied, such as pioglitazone (Actos) and rosiglitazone (Avandia), or
so-called thiazolidinediones, were found to have the opposite effect,
increasing levels of the artery-clogging fat by the same amount.
Researchers say the main drawbacks to metformin are
digestive problems and diarrhea.
Previous reports have found evidence that the
medication leads to the buildup of lactic acid in the blood in people
with moderate kidney or heart disease, and they note that it should not
be prescribed to anyone with either of these conditions.
The main advantages to both newer
thiazolidinediones were a small increase in HDL or good cholesterol, and
less too-low blood sugar levels than three other older, cheaper drugs
studied -- glimepiride (Amaryl), glipizide (Glucotrol), glyburide
(Micronase, DiabBeta, Glynase PresTab) -- known as second-generation
sulfonylureas.
Annual treatment with metformin or the
sulfonylureas, they note, costs on average $100, roughly one-fourth the
cost of oral diabetes medications FDA-approved since then, including the
two newer thiazolidinediones, both approved in 1999. (Their price is
expected to drop once generic versions 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.
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).
Among the teams other findings were that
glimepiride, glipizide, and glyburide led more frequently to too-low
blood sugar levels than the other drugs. The sulfonylureas and acarbose
appeared to have no effect on bad cholesterol. And except for metformin
and acarbose, drug treatment led to an increase in weight from 2 to 11
pounds.
Researchers also noted the increased risk of heart
failure, albeit small (less than three people in a hundred), in people
taking thiazolidinediones who did not have a history of heart disease.
They also caution that despite recent reports about the potential for
increased risk of heart attack from rosiglitazone, there is not yet
sufficient information to verify the finding.
Researchers say further studies are needed to
compare the long-term effectiveness of one treatment to another and to
compare drug effects on quality of life and life expectancy. Additional
research will also be needed to compare these findings with results for
injectible medications for diabetes, most notably insulin, which was not
included in the latest report.
Editors Notes:
The study, conducted solely at Hopkins, was
supported with funding from the federal Agency for Health Care Research
and Quality. The agency has posted the analysis, along with a
question-and-answer document, on its Web site at
http://www.effectivehealthcare.ahrq.gov/reports/final.cfm. And the
consumer watchdog publication, Consumer Reports, has posted a related
report at
http://www.CBestBuyDrugs.org.
Besides Bolen, other researchers involved in the
study were Leonard Feldman, M.D.; Jason Vassy, M.D., M.P.H.; Lisa
Wilson, B.S., Sc.M.; Hsin-Chieh Yeh, Ph.D.; Spyridon Marinopoulos, M.D.,
M.B.A.; Crystal Wiley, M.D., M.P.H.; Elizabeth Selvin, Ph.D.; Renee
Wilson, M.S.; Eric Bass, M.D., M.P.H.; and Frederick Brancati, M.D.,
M.H.S.
For additional information, go to:
http://www.hopkinshospital.org/Diabetes/
http://www.annals.org
http://www.diabetes.org
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