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Older diabetes drugs as good as new, analysis shows

MARILYNN MARCHIONE

Associated Press

Latest comment posted at 9:28 AM EST 18/07/07

The clear winner: metformin, sold as Glucophage and generically for about $100 (U.S.) a year. ...Read the full article

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  1. R B from Vancouver, Canada writes: Why are they comparing drugs that do different things? Metformin has a completely different function than, say glyburide. And many diabetics must take a combination of drugs. The article seems to imply that one should take metformin instead of the others.
  2. James Cyr from Balmertown Ontario, Canada writes: The article is implying that older drugs such as Metformin may be as good or better than Avandia. The article also implies that Metformin may be safer. Of course all these drugs have side effects, but if there is indication that Avandia is tied to heart problems, it may be worth not taking it.
  3. R. M. from Regina, Canada writes: Metformin generic is Glycon in Saskatchewan and I would assume elsewhere in Canada. I am taking it with no side effects and after increasing the dosage am seeing a slight reduction in blood sugar readings.
  4. Jon W-E from Farm in Alberta, Canada writes: Could it be that diabetics are getting heart problems because of their poor lifestyle habits for many yrs (which also brought on the diabetes? ) or is it actually because of a certain medication? Ive always wondered that since Im diabetic myself...
  5. Wally Grisold from Toronto, Canada writes: I've been on Metformin since 2001 and Glyburid since 2004. They have kept my blood-sugar very stable (about 5-6). With Type 2 I have watched my diet, a couple of beers or a glass of wine once in a while keep my "spirits" up. Life goes on and I dread the day if it ever comes that I am listed as Type 1.
  6. lary waldman from Qualicum Beach, Canada writes: When I was first diagnosed I wanted to be on the cutting edge , so I agreed to take Avandia. As I was still in a state of denial, tested infrequently and went more by the way I felt then by any other technical measure (blood tests), I don't know for sure if the Avandia was a good choice or not. After moving to Toronto, for a short period of time, and getting to see a new Family Physician, he immediately stopped the Avandia, which he had suspicion about. (he spent some years as a researcher, so I followed his advice) I have now been taking Metformin and some Glyburide daily, but frankly folks it was the introduction of bike riding, exercise, that I believe turned things around for me to the point that I am as steady, in my three times a day blood sampling as one could hope to be. By all means follow your doctors orders, but getting off the couch can make more of a difference then you might think. Also attending a Provincially funded Diabetic Education course through your Provincial Health Nurse, was a very educational experience, and help a lot. They say a type II diabetic is a Type I diabetic in waiting. I hope to prove that profecy wrong.

    LW
  7. Jay Wortman MD from Vancouver, Canada writes: Type 1 diabetes occurs when an auto-immune response destroys the beta cells in the pancreas resulting in a complete loss of the capacity to produce insulin. These people will always need to use insulin.
    Type 2 diabetes occurs when a person develops insulin resistance and the pancreas loses its ability over time to produce enough insulin to compensate. These people can be treated with diet, exercise, pills or insulin depending on the severity of their condition.
    Somebody with type 1 can develop type 2 but it would be a rare chance occurance for somebody with type 2 to develop type 1. When somebody with type 2 requires insulin, it does not mean they have type 1.
    A good way to achieve blood sugar control, whether you have type 1 or type 2, is to restrict the amount of carbohydrate you eat since this is the main dietary driver of blood sugar. Using this approach, type 2's can often get completely off their meds and type 1's can reduce their insulin requirements.
    To learn more about this, have a look at "Atkins Diabetes Revolution" by Vernon and Eberstein which is supposed to be out in paperback soon or visit the website of Dr. Richard Bernstein: http://www.diabetes-normalsugars.com/
  8. OK from Ontario from Toronto, Canada writes: I had a friend who's dad died of complications associatied with type 2 diabetes. Yes he was insulin dependant. My friend later developed it as well during a period of obesity. He literally cured himself, not requiring drugs. Now it seems that he developed type 1, and is insulin dependant. I don't know how that happened. I married a type one diabetic, who has had it since age 11, 19 years ago. Everything I've learned about diabetes since indicates that type 2 can be cured. As Jay said, watch the carb intake, and exercise exercise exercise. Another good receipe book is the Glycimic Index Diet - basically lots of fibre, whole wheats (preferably stone-ground), and very little fat and simple carbs (white bread, regular pasta). So Larry - there is hope, but you really have to work for it. Buy an active dog and take it out for long walks, or join a hiking group in your area. Take up kyaking, cross country skiing whatever. Just become more active and eat a healthy diet - lots of fish, esp salmon, and whole wheat bread, pasta etc. Lots of fibre.
  9. Bob Lewis from Aylmer, Ontario, Canada writes: I am 60 yrs old and have had Type 2 Diabetes for about 15 years. I take the maximum amount of Gluconorm (Repaglinide), Avandia and Metformin with (as far as I can tell) no major side effects. I also take 5 different medications for blood pressure also with no major side effects. I weighed 256 lbs wondering why I was tired all the time. About a month ago my Dietician (God bless her) gave me a book called "You-On A Diet" by Drs. Roizen and Oz. This has changed my life. In the last three weeks I have lost 10 lbs., 3 inches off my waist and feel much better. My goal is to get rid of all my Diabetes medication by getting my weight to where my body will look after itself. My Diabetes Doctor told me there is a new medication in use in the U.S. but not available in Canada yet (what else is new) to replace Avandia for those who are worried about the extra 14 people out of 15,000 that died of heart attacks. It is called Sitagliptin.
    I'll report back as to my progress on my diet and exercise lifestyle change.
  10. Brian Lilly from Moncton, NB, writes: Good for you Larry Waldman, I guess that DOCTOR really knows best!! I contracted Diabetes type 2 after a serious battle with Wegeners granulamatosis which damaged my pancreas. I am now on 2 doses per day (500 mg ea.) of Metformin as per my doctor's prescription. I exercise a lot every day, and my A1c is usually around 6, and after 18 months, I am doing great. If one follows the diet prescribed by your doctor/dietitian, with the proper medications, and excercise, most people can lead normal lives.
  11. GlynnMhor of Skywall from Canada writes: Glyburide stimulates increased insulin secretion from the pancreas, Metformin suppresses the tendency of the liver to convert glycogen into glucose for release into the blood, and Avandia increases the insulin sensitivity of the body's cells, thus removing glucose from the blood.

    These are all different mechanisms in the body's system of feedbacks that are supposed to control blood-sugar levels (and which aren't working as well as they ought for type-II diabetics).

    It's not at all clear from anything I've read whether the .09% greater death rate seen with Avandia was among those sensitive to some side-effect, or who had other risk factors (like high blood pressure or poor cholesterol control) for heart problems, or whether the increased risk was general across the whole type-II population.

    We need to know more, since Avandia is more effective in lowering blood sugar levels and furthermore attacks the problem at one of its major root causes- the resistance to insulin in the body's cells.
  12. GlynnMhor of Skywall from Canada writes: Bob Lewis from Aylmer, Ontario, Canada writes:"... replace Avandia for those who are worried about the extra 14 people out of 15,000 that died of heart attacks. It is called Sitagliptin."

    I checked Sitagliptin out, and it looks more like a substitute for Glyburide, since it increases insulin secretion. Actos, or Pioglitazone, would be a replacement for Avandia. It's been available for less time than Avandia, however, so it might well have surprise side-effects as well. The pharmaco's website explicitly warns about heart failure and fluid retention, as well as liver side-effects.

    http://www.actos.com/actos/home.aspx
  13. John H Moran from Canada writes: I am a type 2 insulin dependant diabetic.I cannot tolerate metformin and have been taking Avandia for many years.My disease is well controlled and free of complications.Many of my ancestors and my siblings also have diabetes.Most of them are thin, athletic people.I am convinced that most of us inheirited the disease.I do not disagree that life style can influence the development of the disease, but if older family members have it. beware, it may be coming.
  14. M M from Toronto, Canada writes: I am baffled how cost precedes sound medical judgment in the family practice. I am type 2 and have taken the time to educate myself on the available oral meds to help control my blood sugars. I agree that the inexpensive sulfs and metformin are just as adequate as the more expensive TZDs (Actos, Avandia); HOWEVER, sulfs and metformin are band-aid solutions, whereas TZDs target the core of the problem: insulin resistance. Sulfs simply induces the pancreas to produce more insulin (over time burning out the pancreas). Metformin is also a band-aid solution and like sulfs do not target what over 90% of type 2 diabetics suffer from: insulin resistance! TZDs do not stress your pancreas or affect your liver’s function but rather help at a cellular level to decrease insulin resistance. Over time, the effects of TZDs are not diminishing as seen with other oral medications, and have offered me superb results. As for the CV effects, Avandia is riskier but what the FDA is asking Avandia makers to study, Actos has already done! There are no CV effects with Actos. In fact, the opposite is actually the case. HDL (good cholesterol) goes up and bad triglycerides go down. Yes, LDL goes up but not to the detriment of the heart. You don’t have to take my word for it – read the medical journals yourselves. I have taken extensive time to understand my meds. I have since switched from Avandia to Actos because of the better CV effects and have had amazing control of my sugars. I don’t mind any cost issue because when you think of the alternative, having a burned out pancreas in the end is much more costly - both in the wallet and in life years. And my grandkids want me around as long as possible. So I encourage you to challenge your older physician who may simply be a creature of old habit and cost concerns. When it’s your life you’re dealing with, it’s the long term costs that I would be concerned with, not the upfront foresight-lacking short term costs. You owe it to yourself.

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