Older Diabetic Drugs as effective

Older Diabetes Drugs at Least as Effective as Newer Ones

Physician's First Watch for July 17, 2007

Older oral drugs for type 2 diabetes are at least as effective as newer agents, according to a systematic review released early online in Annals of Internal Medicine.

The review included data from more than 200 studies of older diabetes agents (metformin and second-generation sulfonylureas) and newer drugs (e.g., thiazolidinediones). Among the findings:

• Most agents lowered hemoglobin A1c to a similar extent.
• Metformin was the only drug that decreased LDL cholesterol and one of the only ones that didn't increase body weight.
• Thiazolidinediones raised HDL cholesterol but also increased LDL cholesterol.
• Second-generation sulfonylureas were associated with greater risk for hypoglycemia; metformin with gastrointestinal symptoms; and thiazolidinediones with edema.

The authors conclude that metformin "seemed to have the best profile of benefit to risk." They note that metformin and sulfonylureas offer three advantages over newer agents: "lower cost, longer use in practice, and more intensive scrutiny in long-term trials."

Annals of Internal Medicine article (Free)