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Older, cheaper diabetes drugs more effective, safe

Monday, July 16, 2007

CR Best Buy Drugs Report: New Oral Diabetes Medicines No More Effective, Safe than Lower-Cost, Older Drugs

Metformin best first-step choice for most people with diabetes

(Washington, D.C.) – Newer prescription drugs to treat type 2 diabetes – including much-promoted Avandia and Actos – are no more effective or safe than older drugs and cost significantly more, according to the latest report from Consumer Reports Best Buy Drugs®, a public information project of Consumers Union.
“This is truly significant information for the millions of people with diabetes struggling to control their disease, but also struggling with the high cost of their medications,” said Gail Shearer, project director of Consumer Reports Best Buy Drugs. “The evidence shows that lower-cost, older medicines work just as well for most people.”
The report is based primarily on an in-depth analysis being released today of the scientific evidence on oral diabetes drugs by researchers at Johns Hopkins University. The analysis screened the findings of over 216 published studies and was sponsored by the federal Agency for Healthcare Research and Quality. An article based on the new analysis is being published today on the Web site of the journal Annals of Internal Medicine.
The Consumer Reports Best Buy Drugs report presents the complex research findings of the Johns Hopkins team in a consumer-friendly format, including detailed side-by-side comparisons of 11 diabetes drugs and a rundown of the monthly costs for all doses of the drugs. It is available free on the project’s Web site http://www.crbestbuydrugs.org/
Diabetes drugs received wide attention this spring when a study found a possible link between Avandia and a higher risk of heart attacks. That risk remains unclear, however, according to the new report. The report cites other reasons Avandia would not be a wise first choice drug for most people with diabetes, including the higher risk it poses of heart failure compared to other diabetes pills.
Several new types of diabetes drugs have become available in the last few years, further complicating the choice of drugs for 21 million Americans who have the condition. The Best Buy Drugs report clarifies the options, and will help people with diabetes talk to their doctors about what is best. The report does not evaluate insulin or other diabetes drugs that must be injected.
The report chooses three low-cost generics as Best Buys – drugs that are effective, as safe as any other used to treat the condition, and offer the best value for the money. The three are metformin, glipizide, and glimepiride. These medicines range in cost from $10 to $60 a month. In contrast, brand-name Avandia costs $131 to $262 a month, depending on dose. Actos costs from $142 to $221, depending on dose, and another new brand-name diabetes drug, Januvia, costs around $200 a month.
The report recommends that most people newly diagnosed with diabetes talk to their doctor about taking metformin first. This medicine is as effective at lowering blood sugar as any other diabetes drug but does not cause weight gain, and poses a low risk of hypoglycemia (low blood sugar). Weight gain and hypoglycemia are vexing problems with several other types of diabetes pills. In addition, most people who take metformin get a slight lowering of their “bad” (LDL) cholesterol.
Health officials agree that a diabetes “epidemic” is underway in the U.S. About 7 percent of the population has diabetes, up from 2.5 percent in 1980. Among the young, diabetes has paralleled the rapid rise in overweight and obesity, and the two are linked – obesity triggers diabetes in ways that are still not entirely clear.
But older Americans remain most affected; one in five people over the age of 60 has diabetes. And the majority of these older Americans with diabetes have co-existing medical conditions such as heart disease, high blood pressure or high cholesterol. They must often take many drugs at substantial expense.
“For millions of older people with diabetes, especially those with no health insurance, the need to keep their drug bills down can not be overemphasized,” Shearer said. “Our report will help assure they can afford the medicines they need.”
The Best Buy Drugs report also supports the growing medical consensus that lifestyle changes are an essential component of diabetes care, and can often eliminate or reduce the need for drugs. At the same time, the report concurs that the evidence is strong that many people with diabetes will need – and can benefit from – taking more than one drug to keep their blood sugar levels in the normal range. This strategy works, the Johns Hopkins’ analysis shows, but also adds to the risk of adverse effects if the doses of the drugs are not carefully monitored.
The Best Buy Drugs diabetes report is the 18th in a series helping consumers find effective and safe medicines that give them the most value for their health-care dollar. Other reports compare medicines to treat depression, high blood pressure, heartburn, high cholesterol, asthma, allergies, migraines, insomnia, and overactive bladder.
Consumer Reports Best Buy Drugs® combines a review of the scientific evidence on the effectiveness and safety of medicines with pricing information. Every report is peer-reviewed by medical experts. The project is independently administered by Consumers Union and Consumer Reports with support from the Engelberg Foundation, a private philanthropy, and the National Library of Medicine.
Contact: Susan Herold, 202-462-6262