Which Diabetes Drug Is Best?
No single drug to treat type 2 diabetes stands out from the pack when it comes to reducing the risks of heart disease, stroke or premature death, a new research review finds.
The analysis of hundreds of clinical trials found no evidence that any one diabetes drug, or drug combination, beats out the others.
Researchers said the results bolster current recommendations to first try an older, cheaper drug -- metformin (Glumetza, Glucophage) -- for most patients with type 2 diabetes.
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"There are very few things experts agree on, but this is one of them," said Dr. Kevin Pantalone, a diabetes specialist at the Cleveland Clinic and a member of the Endocrine Society.
"Metformin, in the absence of contraindications or intolerability, should be the first-line agent to treat patients with type 2 diabetes," he said.
Metformin can cause upset stomach and diarrhea, so some patients are unable to stick with it day to day, explained Pantalone, who wasn't involved in the study. And people with kidney disease generally shouldn't take it, he said.
The disease, which is often linked to obesity, causes blood sugar levels to be chronically high. Over time, that can lead to complications, such as heart disease, stroke, kidney failure and nerve damage, the CDC says.
There are numerous classes of medications that lower blood sugar levels.
What's been unclear is whether any of those drugs work better than others in warding off diabetes complications and extending people's lives.
The new analysis found no obvious winners.
But the researchers also cautioned against drawing conclusions: The trials in the review were not specifically designed to see whether any of the medications prolong people's lives.
Mainly, they looked at "biochemical" effects -- like whether the drugs lower blood sugar, explained Suetonia Palmer, the lead researcher on the work.
"So what we know is that currently, there is no good evidence that one drug can improve life expectancy better than another -- either when they are used as the only drug for treatment, or when added to metformin," said Palmer. She's an associate professor in the Department of Medicine at the University of Otago, in New Zealand.
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