Metformin should be the first line of defense in treating type 2 diabetes in patients who don’t respond to diet and lifestyle changes, according to new guidelines published in the Annals of Internal Medicine. Second medications can be added if metformin alone fails to control high blood sugar, but there is no evidence to suggest one type of diabetes medication works better than the other.
Amir Qaseem, MD, PhD, director of clinical policy at the American College of Physicians, and fellow researchers said that most diabetes agents managed to control blood sugar levels, but metformin was most effective at lowering blood sugar levels when both used alone or with other type 2 diabetes drugs.
There are currently 11 classes of drugs approved by the Food and Drug Administration (FDA) to treat type 2 diabetes. Most patients receive more than one of these medications at a time. While diet and lifestyle change is the optimal treatment, most patients eventually require medication to manage their blood sugar. When metformin alone doesn’t achieve the desired results, other drugs can help.
Researchers say no other therapy stands out as being better than the other at controlling blood sugar than the other. But many have undesirable side effects.
For example, two drugs in the thiazolidinedione class, Avandia (rosiglitazone) and Actos (pioglitazone) have been associated with serious adverse reactions. Last year the FDA severely restricted the use of Avandia after studies linked it to heart failure. Soon after, the agency issued a warning that Actos had been linked to bladder cancer.
Researchers suggest that before clinicians prescribe their patients another drug, they should take into account other complicating factors including life expectancy, heart problems, risk for adverse events related to blood sugar control, and patient preference.
ACTOS is a trademark of Takeda Pharmaceutical Company Limited registered with the U.S. Patent and Trademark Office and used under license by Takeda Pharmaceuticals America, Inc. AVANDIA is a registered trademark of GlaxoSmithKline.
Source: MedPage Today