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Metformin Preferred Drug for Type 2 Diabetes, Experts Say

February 16, 2012
By

MONDAY, Feb. 6 (HealthDay News) —
When it comes to the treatment of type 2 diabetes, the first line of
defense is lifestyle changes such as losing weight and exercising more
often.

But, if those lifestyle changes don’t get blood sugar levels under
control, the American College of Physicians (ACP) recommends the drug
metformin as the first oral treatment that should be given.

If metformin alone can’t control blood sugar levels, the ACP advises
combining metformin with another blood-sugar lowering medication. But, the
evidence isn’t yet strong enough for the doctor’s group to recommend one
medication over another for combination therapy.

“Most diabetes medications do lower [blood sugar], but metformin is
more effective with fewer side effects. And, the cost is less,” said Dr.
Amir Qaseem, director of clinical policy at the American College of
Physicians, and the lead author of the new guidelines.

However, the ACP is recommending that metformin only be prescribed
after someone has tried to change his or her lifestyle, he added.

“Diet, exercise and weight loss are so important in controlling type 2
diabetes. You can’t just give pharmaceutical agents and not have lifestyle
changes,” Qaseem said.

The new guidelines are published in the Feb. 7 issue of the Annals
of Internal Medicine
.

Type 2 diabetes is a disease that causes high blood sugar levels. Over
time, this can lead to blood-vessel damage in the eyes, kidneys, heart and
nerves. Almost 26 million Americans have diabetes, and as many as 95
percent of those have type 2 diabetes, according to the new guidelines.

“Diabetes is a really important health-care issue in this country. It’s
a major cause of morbidity and mortality, and the prevalence of the
disease is going up,” Qaseem said.

Obesity and a sedentary lifestyle are significant risk factors for type
2 diabetes, although not everyone who has the disease is overweight.

There are currently 11 different classes of medications approved by the
U.S. Food and Drug Administration for the treatment of type 2 diabetes,
according to the guidelines. These medications work by lowering blood
sugar levels.

To come up with the new guidelines on oral diabetes treatments, the
reviewers looked at data for each available class of medication to assess
how effective it was in lowering blood sugar, cholesterol and weight. They
also looked at how much each medication was able to reduce the risk of
complications from type 2 diabetes. And, they reviewed the safety of each
type of medication.

They found that metformin was the most effective in lowering hemoglobin
A1C (HbA1C) levels. HbA1C levels are a measure of long-term blood sugar
control, estimating average blood sugar levels over several months.

The researchers also found that combination therapy with two drugs was
more effective at lowering HbA1C than therapy with just one agent.
However, when comparing different combination therapies, no particular
combination stood out as superior to the others.

Metformin also appeared to be the most effective medication for
lowering levels of LDL (bad) cholesterol, according to the guidelines.
Metformin also seemed to be more effective at preventing all-cause
mortality and heart disease.

Dr. Joel Zonszein, director of the clinical diabetes program at
Montefiore Medical Center in New York City, said he would recommend
starting medication along with lifestyle changes, instead of waiting to
see if lifestyle medications work or not.

“Lifestyle changes fail in the majority of people. Why wait to start
treating them? There should not be inertia. If you’re more aggressive
early in the disease you may be able to protect some of the beta cells,”
he said. Beta cells are cells in the pancreas that produce insulin, a
hormone needed to metabolize carbohydrates in food.

Zonszein also said that many of the studies used to develop the new
guidelines were short-term studies, often sponsored by drug manufacturers.
He said to really know what treatments are best, longer-term studies are
needed, as are studies that look at different combinations of diabetes
medications.

He said he also would have liked the guidelines to address the use of
cholesterol-lowering medications and blood-pressure lowering medications,
as these are common problems seen in people with type 2 diabetes.

More information

The American Diabetes Association has more information on the types of
oral medications available for type 2 diabetes.

Article source: http://news.yahoo.com/metformin-preferred-drug-type-2-diabetes-experts-220211508.html

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