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Metformin for type 2 diabetes as good as newer, expensive drugs

Kathleen Blanchard's picture

Johns Hopkins researchers compared newer diabetes drugs that are more costly to metformin that has been on the market for 15 years. They found metformin has fewer side effects and found no evidence that brand name newer drugs to treat type 2 diabetes are any better.

Metformin has fewer side effects, controls blood sugar

In the analysis most of the diabetes drugs controlled blood sugar levels, but newer diabetes drugs were found to increase the risk of dangerous side effects.

The researchers investigated diabetes drugs in 2007. As a follow-up study, they added two newer types of diabetes drugs for comparison to metformin - Byetta and Victoza that are given by injection.

Dr. Wendy Bennett, an assistant professor of medicine at Johns Hopkins University School of Medicine in Baltimore, the study's lead author said, "Metformin continues to be an inexpensive medication and it's very efficacious."

The most common side effect of metformin is stomach upset that Dr. Bennett says most of her own patients cope with by starting at a lower dose and taking the drug with food.

Medications like Avandia, Amaryl, Actos, Januvia, Glucatrol, Prandia and Starlix, that come with exorbitant price tags were found to have more side effects that include weight gain, fractures. Diabetes drugs in the thiazolidinedione class (Actos and Avandia) carry the risk of congestive heart failure.

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Dr. Bennett explains some of the drugs haven't been on the market long enough to evaluate all of the side effects, short or long-term.

Brand name diabetes drugs cost 18 times more than metformin that the researchers found controls blood sugar as well as newer, more expensive drugs. For the study, the scientists also looked at combination drugs to treat the disease that they found work better for difficult to control diabetic blood sugar levels.

The findings came from a review of 166 published medical studies. Outcomes considered included death, cardiovascular disease, kidney disease and neuropathy.

“Diabetes is an enormous public health problem, and patients have difficult decisions to make about what medications they should be taking,” Bennett says. “Our study provides good information comparing drugs and can be used to inform those decisions.”

Diabetes drugs known as meglitinides (Starix, Prandin) increase the risk of hypoglycemia or low blood sugar.

The authors concluded evidence shows metformin controls type 2 diabetes as well as newer, expensive brand name medications with fewer side effects and can be used as a first-line treatment for the disease. The findings are published March 15 in the Annals of Internal Medicine.

Annals of Internal Medicine
"Comparative Effectiveness and Safety of Medications for Type 2 Diabetes: An Update Including New Drugs and 2-Drug Combinations"

Wendy L. Bennett, MD, MPH; Nisa M. Maruthur, MD, MHS; Sonal Singh, MD, MPH; Jodi B. Segal, MD, MPH; Lisa M. Wilson, ScM; Ranee Chatterjee, MD, MPH; Spyridon S. Marinopoulos, MD, MBA; Milo A. Puhan, MD, PhD; Padmini Ranasinghe, MD, MPH; Lauren Block, MD; Wanda K. Nicholson, MD, MPH; Susan Hutfless, PhD; Eric B. Bass, MD, MPH; and Shari Bolen, MD, MPH



Kust recently diagnosed with type II diabetes, and I'm prescribed Metformin, just wishing to investigate the pros and cons using this medication, how soon will it effect my glucose readings, maximum dosages daily?. I also have cardio-vascular issues, on Plavix and two blood pressure controllers along with baby aspirin and lyrica. I have had two toes removed due to infection and poor circulation, and have blockages in my lower legs which have been treated with a graft with bovine arterial implants, a number of stents during three angio-plasty procedures in the last year. As of this coming Tuesday I will receiving a second grafted operation now in my right groin removing a portion of my lower fermoral artery and being replaced with aa length of bovine.
ive been taking metformin for 3 years now and have had no side effects which is a plus. no weight gain, actually lost a lot. no drops in bllod sugar that some can cause either. all in all i wouldnt change what works
Thank you for the feedback! It helps other people with diabetes to hear 'first hand' accounts from others.
Was wondering; what is the correlation between metformin and alcohol? I take metformin 2x a day, am very careful about diet, exercise (I either walk or ride my bike for 30-45 minutes a day and checking my blood sugar levels frequently, but I do drink socially which means having a few drinks (vodka and diet soda or diet juice drink as a mixer) or maybe a couple of glasses of red wine with friends and family, sometimes during the week and sometimes on weekends. Was diagnosed about a year and a half ago, my A1C was 5.3 last time it was checked.