What’s the Best Drug for Type 2 Diabetes? The Answer Isn’t Simple

September 1st, 2011 by Ryan Luce No Comments

Written by Michael O'Leary

With all the new FDA-approved drugs for type 2 diabetes lately, the question arises, is your current prescription the best for you? With names like Onglyza, Januvia, Byetta, Prandin, Tradjenta, metformin, Amaryl, it can be confusing even to know what to ask your doctor.

In a “best evidence review” published Aug. 30 in MedScape News, Dr. Charles Vega, associate professor in the Department of Family Medicine at the University of California, Irvine, compares the effectiveness and safety of all the medications for type 2 including the newest ones being marketed. At least that’s what he wanted to do. (Link to published site)

Vega’s review is based on a pooled-data analysis funded by the Agency for Healthcare Research and Quality and published in the August Annals of Internal Medicine. The agency is the health services research arm of the U.S. Department of Health and Human Services. It examined 140 clinical studies and 26 observational studies published in major medical databases before April 2011.

If you were hoping for a Consumer Reports list of “best buys,” however, Vega wrote that, “Unfortunately, there is little data comparing different medications regarding clinical outcomes.”

In other words the pooled-data analysis didn’t really shed light on which drugs do the best job in reducing long-term outcomes such as heart disease, blood vessel disease, diabetes complications and death. Instead most of the studies focused on short-term effects on blood glucose and other measures of diabetes control. Only 25 of the studies even lasted more than two years.

Nevertheless, Vega was able to pull out a few clinical “pearls” of helpful information from the pooled-data analyis:

• Diet and exercise can significantly improve A1c values among patients with type 2 diabetes, but they cannot be expected to reduce A1c more than 1 percent.
• There are little data to guide clinicians on treatment of type 2 diabetes based on effectiveness in preventing major complications of diabetes or death.
• Most single-drug treatments for type 2 diabetes can be expected to reduce A1c values by approximately 1percent.
• Adding additional therapy to single medications for diabetes can be expected to reduce A1c values by an additional 1 percent.
• Metformin is a good first-choice medication for the treatment of type 2 diabetes. Long-acting sulfonylureas should be avoided in high-risk patients.
• In general, high-risk patients have a target A1c level of less than 7 percent. Younger patients without comorbid conditions may be treated to a lower A1c target.

“Physicians need to account for individual patient factors in deciding on a plan of care,” Vega concluded. “Fortunately, we understand more about the nuances of diabetes treatment than in the past, and there are more options to choose from in helping patients to reach their treatment goals. However, there are also substantial gaps in our collective knowledge of the treatment of diabetes, particularly with regard to important patient-related outcomes such as microvascular disease, macrovascular disease, (blood vessel damage) and mortality. Further research should be performed to better inform patients and physicians regarding the best treatment choices for type 2 diabetes.”