July 2007
Older drugs are the best choice for most people with type 2 diabetes
Most people with type 2 diabetes should avoid new, heavily advertised drugs--notably Avandia and Actos--because older medications
are cheaper, just as effective, and as safe if not safer, according to a new study and a report based on it from Consumer
Reports Best Buy Drugs.
Diabetes drugs received wide attention last spring when research found a possible link between rosiglitazone (Avandia) and a higher risk of heart attacks. While those risks remain unclear, the CR Best Buy Drug report cites other reasons that rosiglitazone and the related drug pioglitazone (Actos) are not wise first choices for most people with diabetes, including their higher risk of heart failure compared with other diabetes drugs. Indeed, in May 2007 the Food and Drug Administration requested that the manufacturers of Actos and Avandia put a high-profile "black-box" warning about the risk of heart failure on the labels of the two drugs.
Instead, the report recommends that most people with diabetes first talk with their doctor about taking metformin (Glucophage and generic). That medicine not only controls blood sugar as effectively as all other diabetes drugs, but also reduces the level of "bad" LDL cholesterol, doesn't cause weight gain, and is less likely than most diabetes drugs to cause dangerously low blood sugar (hypoglycemia). Moreover, the generic version of the drug costs just $38 to $60 per month compared with $142 to $262 for Actos and Avandia, depending on the dose.
If you are unable to take metformin or don't tolerate it well, or if metformin alone doesn't adequately control your blood sugar level, the CR Best Buy Drug report recommends trying or adding either glimepiride (Amaryl and generic) or glipizide (Glucotrol and generic). While those drugs, called sulfonylureas, do pose a higher risk of hypoglycemia than Actos and Avandia, they're less likely to threaten the heart. And the generic versions of glimepiride and glipizide cost less than generic metformin.
The report concludes that Actos, and especially Avandia, should be reserved for the small number of people with diabetes for whom metformin, glimepiride, or glipizide prove ineffective or intolerable.
The report is based primarily on an in-depth analysis by researchers at Johns Hopkins University. The analysis was sponsored by the federal Agency for Healthcare Research and Quality, and aggregated the findings from 216 prior diabetes studies. The new analysis appears online at the Web site of the journal Annals of Internal Medicine. For the full Best Buy Drugs Report, go to www.CRBestBuyDrugs.org.
Diabetes drugs received wide attention last spring when research found a possible link between rosiglitazone (Avandia) and a higher risk of heart attacks. While those risks remain unclear, the CR Best Buy Drug report cites other reasons that rosiglitazone and the related drug pioglitazone (Actos) are not wise first choices for most people with diabetes, including their higher risk of heart failure compared with other diabetes drugs. Indeed, in May 2007 the Food and Drug Administration requested that the manufacturers of Actos and Avandia put a high-profile "black-box" warning about the risk of heart failure on the labels of the two drugs.
Instead, the report recommends that most people with diabetes first talk with their doctor about taking metformin (Glucophage and generic). That medicine not only controls blood sugar as effectively as all other diabetes drugs, but also reduces the level of "bad" LDL cholesterol, doesn't cause weight gain, and is less likely than most diabetes drugs to cause dangerously low blood sugar (hypoglycemia). Moreover, the generic version of the drug costs just $38 to $60 per month compared with $142 to $262 for Actos and Avandia, depending on the dose.
If you are unable to take metformin or don't tolerate it well, or if metformin alone doesn't adequately control your blood sugar level, the CR Best Buy Drug report recommends trying or adding either glimepiride (Amaryl and generic) or glipizide (Glucotrol and generic). While those drugs, called sulfonylureas, do pose a higher risk of hypoglycemia than Actos and Avandia, they're less likely to threaten the heart. And the generic versions of glimepiride and glipizide cost less than generic metformin.
The report concludes that Actos, and especially Avandia, should be reserved for the small number of people with diabetes for whom metformin, glimepiride, or glipizide prove ineffective or intolerable.
The report is based primarily on an in-depth analysis by researchers at Johns Hopkins University. The analysis was sponsored by the federal Agency for Healthcare Research and Quality, and aggregated the findings from 216 prior diabetes studies. The new analysis appears online at the Web site of the journal Annals of Internal Medicine. For the full Best Buy Drugs Report, go to www.CRBestBuyDrugs.org.
