NYT Article Says Older Diabetes Drugs Are Often the Best

Newer And More Expensive Drugs

| Jul 20, 2011

A recent article in the New York Times says that such old prescription diabetes drugs as metformin and generics such as glimepiride are often as effective as or even more effective than newer, more expensive drugs.

Among the article's highlights:
• Americans with diabetes spent more than $12.5 billion on diabetes drugs in 2007-a figure that is almost certainly higher now.
• Safe, cheap, effective metformin remains the preferred "first-line" drug for treating diabetes.
• Older drugs, such as sulfonylureas, have become cheaper as generics have become available. They remain reliable therapies for helping achieve blood sugar control.
• Diet and exercise are still the most effective defenses against type 2 diabetes.

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Categories: Fitness, Blood Sugar, Diabetes, Diabetes, Diabetes Drugs, Diets, Exercise, Prostate Cancer, Research, Type 2 Issues

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Posted by Anonymous on 20 July 2011

sulfonylurea therapy does absolutely nothing from a pathophysiology standpoint and physicians should be sued for malpractice in prescribing a medicine that increases atherogenicity, hypoglycemia, and results in guaranteed glycemic failure long-term

Posted by Anonymous on 20 July 2011

This is a fine example of why it's all about the Benjamin's. I will never believe the JDRF, ADA or others are working towards a cure. All they work towards is changing formulas to keep it EXPENSIVE. Once this disease might become just a little bit cheaper to manage, something changes and the price goes up. I have come to embrace the fact that diabetes will end my life before any cure or ethical behavior is exercised by those jacking up the costs and preaching false hopes and empty promises.

Posted by shosty on 21 July 2011

Well said, anonoymous.

And I wish titles and articles like this would specify type 2.

Posted by cde on 22 July 2011

In my experience, for treatment of DM, whether type 1, type 2, or gestational, over the long term, the most effective, perpetually essential, least likely to provoke negative side effects, and cheapest medicine requires no prescription: appropriate food choices and intake.

Food seems to be the recreational drug of (generally insufficiently educated) "choice." High doses of the wrong foods, especially of carbohydrates, can be toxic.

Though the medically useful food choices for a person with DM who attempts to self-manage hyperglycemia through the primordial tactic of "diet" are distinct from those without DM who follow the Standard American (and it is far more global than just "American") Diet (SAD), for the vast majority of persons who have DM, food content and consumption produce immediate results efforts to self-manage stable blood glucose control to within normal or very near normal limits (71-99 mg/dL).

This is not to say that drug therapy (metformin and insulins, for example) cannot still and often be useful. For those persons with diagnosed DM, whose pancreas is unable to respond even to food choices appropriate (as measured by the BG levels that result from eating them), such drugs can be lifesaving and essential...and of course, somewhat expensive.

Dr. Stan De Loach
Certified Diabetes Educator
Mexico, Distrito Federal

Posted by Anonymous on 22 July 2011

This I think applies to insulin also! If no study has been done, it would show same results.

Posted by JamesHazlett on 23 July 2011

As the founding editor of Diabetes Self-Management magazine and it's editor for the first 25 years, I have to second Dr. De Loach's comments. Which foods you eat is important, but how much of those foods you eat is more important. But so is modifying the rest of your lifestyle.

In a world that went from small meals and plenty of exercise to a world of French fries and no exercise in 50-60 years, diabetes has become a major health problem. As difficult as it is, especially once you have already been diagnosed with diabetes, one of the best ways to deal with that diagnosis is to change your lifestyle to one of moderate meals and regular, appropriate exercise. "Appropriate" means different things, depending on what kind of shape you're in.

This is not easy stuff to deal with. I, myself, am guilty of a little too much chow and not enough motion of the bones, but your doctor would endorse this prescription.

Your doctor would also advise you to learn as much as you can about managing your diabetes. The foundation of that management is diet and exercise (and diabetes drugs, as needed).

Again, this is not easy. Learning about diabetes was my full-time job for 25 years, and I didn't find it easy. The way I learned was to ask medical professionals who specialize in diabetes, who, to my delight, were eager to share their knowledge. They still are. Remember, Medicare now pays for diabetes education; ask your doctor about that and take advantage of it. Learn as much as you can. It will pay dividends in better health.

Posted by Jerry1423 on 25 July 2011

As a T1 Diabetic for 37 years I strongly believe the "older" animal based insulins were better than what we have now - as there are hormones in them that are not in the man made insulins.
I have been very frustrated at the direction that diabetes "advancements" have gone in the last 20 years as they are not really advancements - just a differnt way of treating it, that is based on how much money the companies are making.

Posted by jlnhjm on 31 July 2011

As a type 2 whose pancreas is no longer producing insulin, I agree that diet and exercise are just not enough to manage diabetes at this point in my life. I have many conditions that preclude much exercise and I have celiac, which further limits food choices. I use insulin. I started with R and Ultra Lente. Worked for me, but they disappeared. I did have to use humilin, I was apparently allergic to something in the animal insulins. However many people did very well with them, much better than with the present grown in a vat insulins. Yes, it is all about the money, the drug companies can make huge profits from us, and from the gov't. Diabetes is a cash cow that can go on forever. I am 73, I have been dealing with this since 1983, tired of it, see no cure, and, yes, my diabetes does depress me.

Posted by Anonymous on 9 August 2011

I believe it is still 'bang for the buck'! SUs are very inexpensive - but not all are equal there either - scientific information indicates glyburide (for instance) brings along a high risk of cardiovascular mortality that other SUs do not.
I also believe it is important to look at the whole package you get with an anti-DM agent. Weight gain/loss, increased stress and demand on pancreatic beta-cells, risk of low 'sugar', enhancing microcirculation, early use of the best agents that bring the best PACKAGE of therapy to the management efforts. If used earlier vs later, insulin - for instance - is very safe and brings a lot of advantages to care. I started insulin very early and am also 'going off label' using a GLP-1 injectable as well. I lost 20 lbs, my lipids are much better, my BP is lower, and my A1c is 5.2 - I am without low blood sugar because I am using these agents based on my own study and taking responsibility for my own care. It is possible, but I fear there are many health care providers who aren't as good as they could be, likely due to the high and varied work load they contend with - among so many other things.
I don't know if my opinion means squat - but once I decided to take it on myself, I learned one does not have to have an idiot for a patient when caring for oneself.

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