metformin compared to other drugs

[Guest guest]

s Hopkins researchers compare 10 of the top type 2 diabetes medications and

give metformin the top grade.

JULY 2007 PRESS RELEASE

Metformin, a type 2 diabetes drug taken orally and in widespread use for more

than a decade has been found to have distinct advantages over nine other,

mostly newer medications used to control the chronic type 2 diabetes, according

to a study by researchers at s Hopkins.

In their report, published online July 16 in the journal ls 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 metformin 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 diabetes patients struggling

to stay in good health,” says Bolen, an instructor at The s 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 diabetes 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 metformin 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 metformin leads to the

buildup

of lactic acid in the blood in people with moderate kidney or heart disease, and

they note that metformin 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 diabetes 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.)

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 team’s 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.

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.

And the consumer watchdog publication,

Consumer Reports

has posted a related report.

Besides Bolen, other researchers involved in the study were Leonard Feldman,

M.D.; Vassy, M.D., M.P.H.; , B.S., Sc.M.; Hsin-Chieh Yeh,

Ph.D.; Spyridon Marinopoulos, M.D., M.B.A.; Crystal Wiley, M.D., M.P.H.;

Selvin, Ph.D.; , M.S.; Bass, M.D., M.P.H.; and

Frederick

Brancati, M.D., M.H.S.

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