A new review says that there is no one drug to treat type 2 diabetes that stands out as the best among the rest, with regards to reducing the risks for heart disease, stroke or early deaths, Madison reports.
Researchers who had combed through and analyzed hundreds of clinical trials found no evidence that any single diabetes drug or drug combination actually beat out the others. The results support current medical recommendations for type 2 diabetes patients to try older, cheaper drugs first, such as metformin (Glumetza, Glucophage).
Dr. Kevin Pantalone, a diabetes specialist at the Cleveland Clinic ad member of the Endocrine Society, said, “There are very few things experts agree on, but this is one of them. Metformin, in the absence of contraindications or intolerability, should be the first-line agent to treat patients with type 2 diabetes.”
Metformin can cause diarrhea and an upset stomach though, so some patients are not able to use it daily, said Pantalone, who was not a part of the study. People with kidney diseases should refrain from taking metformin as well, he said.
The US Centers for Disease Control and Prevention reports that over 29 million Americans suffer from diabetes, mostly type 2. The disease is often linked to obesity and can lead to further health complications such as heart disease, kidney failure, stroke and nerve damage.
There are many different medications that lower blood sugar levels, and it has been unclear as to whether any of these work better than others in treating diabetes and complications caused by diabetes.
Suetonia Palmer, lead researcher and associate professor at the Department of Medicine, University of Otago in New Zealand said that their study found no winners. They did caution that the trials in their review were not created to see which medications prolonged people’s lives, but looked at “biochemical” effects like whether the drugs lowered blood sugar levels.
Palmer and her team analyzed results from 301 clinical trials that tested nine classes of diabetes drugs altogether, including both older ones like metformin, insulin and sulfonylureas, and newer medicines like DPP inhibitors and thiazolidinediones.
Many of the trials in the study tested only one medication, but over a hundred used a drug combined with metformin. Overall, metformin worked as well, even better than other drugs at reducing blood sugar levels, the study found.
The problem, according to Palmer, is the lack of evidence, which is completely different from proof that the drugs are equal. Pantalone agreed, adding that the analysis included studies that ran for only a short time. He said,
I think the important finding was that there was no signal that one therapy may be more harmful than another from a cardiovascular standpoint.
Pantalone said this is important, because the US Food and Drug Administration has only required diabetes medications to be tested for cardiovascular safety since 2008, so older drugs did not go through the process. There is also evidence that two newer diabetes drugs can actually help reduce mortality risks from heart diseases or strokes: liraglutide and empagliflozin.
Metformin remains the primary drug for type 2 diabetes, Pantalone said, as it not only lowers blood sugar but is also low-risk for hypoglycemia. If another drug is necessary, its addition should be based on the patient’s health and the known side effects of these drugs.
Whatever medication is used, however, Pantalone stressed that a healthy lifestyle for type 2 diabetes patients remains the main contributing factor to a longer life.
The study was published in the Journal of the American Medical Association.
