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