Study: diabetics better off avoiding new drugs in favor of cheaper, safer old ones

A new study published in the Annals of Internal Medicine finds that most type-2 diabetics are better off using older, cheaper diabetes drugs than their heavily advertised, newer counterparts. With the exception of those who cannot tolerate specific drugs like Glucophage (metformin), the effectiveness of the older medications was on par with that of newer drugs Avandia and Actos.

In addition to being equally effective (and in some cases, superior), side-effects were considered less severe and costs considerably lower. Glucophage (metformin) is available in generic form at about $100 for a year’s supply; a month’s supply of Avandia or Actos can be more than twice that.

Consumer Reports created a users’ guide to the information presented in the study, naming the metformin generic as a CR Best Buy. Users for whom metformin alone is ineffective or not well tolerated should consider either glimepiride (Amaryl and generic) or glipizide (Glucotrol and generic). Consumer Reports argued that only the small number of people for whom all of the preceeding drugs prove unusable should consider Actos or Avandia.

While the safety of Avandia is set to be debated before the FDA on July 30th, the drug’s maker GlaxoSmithKline defended the safety and effectiveness of their product in a July 16 press release, arguing that “Avandia is superior in long-term control of blood sugar over five years compared to metformin.” However according to a July 16, 2007 article by CNN, the results come as no suprise to diabetes experts:

The conclusions mirror those of an expert panel that leading U.S. and European diabetes groups convened last year, said Dr. David Nathan, diabetes chief at Massachusetts General Hospital. He has received speaker fees from several diabetes drug makers.

Metformin is “an incredibly inexpensive generic drug, which is why we found it so appealing,” Nathan said.

Also See:

“Older drugs are the best choice for most people with type 2 diabetes.” Consumer Reports. July 2007. <http://www.consumerreports.org/… .htm> (July 17, 2007.)

“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.”

“Analysis: Older, cheaper diabetes drugs get high marks.” CNN.com. July 16, 2007. <http://www.cnn.com/2007/HEALTH/conditions/07/16/diabetes.drugs.ap/index.html> (July 17, 2007.)

“The clear winner: metformin, sold as Glucophage and generically for about $100 a year. It works as well as other diabetes pills but does not cause weight gain or too-low blood sugar, the analysis found. It also lowers LDL or bad cholesterol.”

Press Release: “GlaxoSmithKline Responds to Reviews of Oral Diabetes Medications.” GlaxoSmithKline. July 16, 2007 <http://www.gsk.com/media/press-kits/avandia-16july2007.pdf> (July 17, 2007.)

Bolen, et al. “Systematic Review: Comparative Effectiveness and Safety of Oral Medications for Type 2 Diabetes Mellitus.” Annals of Internal Medicine. September 18, 2007, Volume 147 Issue 6.<http://www.annals.org/cgi/content/full/0000605-200709180-00178v1> (July 17, 2007.)

“Conclusions: Compared with newer, more expensive agents (thiazolidinediones, α-glucosidase inhibitors, and meglitinides), older agents (second-generation sulfonylureas and metformin) have similar or superior effects on glycemic control, lipids, and other intermediate end points. Large, long-term comparative studies are needed to determine the comparative effects of oral diabetes agents on hard clinical end points.”