Older, cheaper diabetes drugs as effective as newer pills, study says

Older, cheaper diabetes drugs are as safe and effective as newer ones, concludes an analysis that is good news for diabetics and may further hurt sales of Avandia, a blockbuster pill recently tied to heart problems.

The clear winner: metformin, sold as Glucophage and generically for about $100 a year. It works as well as other diabetes pills but does not cause weight gain or too-low blood sugar, the analysis found. It also lowers LDL, or bad cholesterol.

"It looks to be the safest," said Dr. Shari Bolen, a Johns Hopkins University researcher who led the review, which was published online Monday by the Annals of Internal Medicine.

Consumer Reports also published a guide to the results. Besides metformin, it rates glipizide and glimepiride, sold as Amaryl and Glucotrol, as best bets.

"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.

Diabetes is epidemic, afflicting more than 18 million Americans, or 7 percent of the population. Most have type 2, which occurs when the body makes too little insulin or cannot use what it does produce. Being overweight raises this risk.

The federal Agency for Healthcare Research and Quality commissioned the analysis of diabetes drugs in 2005, long before a study published in May suggested that Avandia, made by GlaxoSmithKline, raised the risk of heart attacks.

The goal was to do the first in-depth comparison of oral medications that have come out in the past decade, as well as older ones such as sulfonylureas that have been sold for 50 years. The report did not evaluate insulin or other injected diabetes drugs.

Researchers reviewed more than 200 published studies and obtained unpublished information from some drug companies and the federal Food and Drug Administration.

They found that most oral diabetes drugs lower "A1c" levels — a key measure of high blood sugar — by about one percentage point — from 8 to 7, for example (5 is normal for non-diabetics).

Taking two medications can improve blood sugar control but also costs more and can raise the risk of side effects.

Despite heavy marketing for newer drugs, which cost as much as $262 a month, "we didn't find any benefit" unless a patient could not tolerate an older one, Bolen said.

Avandia's safety will be debated at an FDA hearing on July 30. GlaxoSmithKline says Avandia is safe but has not denied reports that sales have fallen about 30 percent since May 21, when a study linked it to heart attacks.