By Serena Gordon
HealthDay Reporter
Monday, March 14 HealthDay News)--Although there are numerous options in oral medications for type 2 diabetes drug metformin-elder-may be the best option for first line, according to a new analysis of research on diabetes medications.
The analysis included six classes of oral medicines for diabetes and found that all they reduce blood sugar levels by a similar amount. The authors suggest that metformin is probably the best choice, because it has fewer side effects than other drugs and, because it is an older medication and available in a generic manner, also costs less.
"Metformin remains a cheap and is very effective," said study author, Dr. Wendy Bennett, an assistant professor of medicine at Johns Hopkins University School of Medicine in Baltimore.
Approximately 26 million Americans have diabetes, according to the u.s. Centers for Disease Control and Prevention. Left untreated, diabetes can lead to numerous complications including eye disease, kidney disease, heart problems and amputations.
There are 11 classes of diabetes medications that are approved for treating high blood sugar in people with type 2 diabetes in the United States. Nine of these classes of medicines are available since 1995, according to background information in the study, which was conducted by researchers at Johns Hopkins University, along with researchers from Case Western Reserve University in Cleveland, Ohio and the University of North Carolina at Chapel Hill.
Most people with type 2 diabetes need to take more than one medication to conveniently control their blood sugar levels, the study authors noted.
The most common serious side effect of any of these medications lower the blood sugar is hypoglycemia, or blood sugar levels low. Other common side effects include gastrointestinal problems, such as a nausea or diarrhea. Bennett said that these side effects may be minimized by starting with a low dosage of medication initially and take it with a meal.
The researchers, who were supported by the u.s. Agency for healthcare research and quality, reviewed a total of 166 current analysis studies. The studies included six classes of medication: metformin (Glucophage, Fortamet and others). Sulfonylureas (Glucotrol, Amaryl and others). thiazolidinediones (Avandia and Actos). Meglitinides (Starlix and Prandin); DPP-4 inhibitors (Januvia and Onglyza). receptor agonists and GLP-1 (Byetta and Victoza).
In General, most medicines reduced levels of Hemoglobin A1C (a measure of long-term control of blood sugar) by one percentage point. The American Diabetes Association recommends that most people with diabetes keep their A1C levels below 7%, so a drop of one percentage point is clinically significant.
The researchers also found that adding a second medication improves blood sugar control, but that no combination of medicines appeared to offer significant benefits over the other.
Metformin was associated with an increased risk of diarrhea, seemed to have the lowest side effect profile, according to the analysis. And, also, cost less, according to the report. Metformin cost about $ 0.35 per pill compared with $ 6. 42 for Januvia, according to the authors of the study.
As a class of medications, thiazolidinediones, which include Avandia and Actos, came under intense scrutiny because of potential serious side effects, and this analysis confirmed that the weight gain, fractures and increased risk of congestive heart failure are associated with thiazolidinediones. Despite heart attacks have also been associated with the class of drugs, this analysis has not been able to confirm or refute an increased risk of heart attack, according to Bennett.
Sulfonylureas and meglitinides were associated with an increased risk of hypoglycemia, the study noted.
The study, which examined 140 randomized controlled and observational studies 26, noted that 95 reported support for pharmaceutical company. In addition, most lasted no more than two years and generally excluded people with type 1 diabetes, the serious coexisting conditions and older.
Study results are published in issue 15 March annals of internal medicine.
Dr. Joel Zonszein, Director of the Diabetes clinic at Montefiore Medical Center in New York, said that this study does not provide much new information.
"As you know, most medicines lowered A1C similarly. The question is which medication to use in which the population of patients? A unique approach is the wrong approach, "said Zonszein.
"There is a huge variability in the patients. Some people have a great answer [to certain drugs], some have none. What we need are studies sponsored by the National Institutes of Health, pharmaceutical, not so they can learn better how to use these drugs in combination, "he added.
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