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In a new study published in the Annals of InternalMedicine and funded by the Department of Health and Human Services' (HHS) Agency for Health Care and Quality Research (AHRQ), it was determined that certain oral diabetes drugs do not lead to an increase in weight or bad cholesterol.

The study was conducted by Shari Bolen, Clinical Fellow at the Welch Center for Prevention, Epidemiology, and Clinical Research at Johns Hopkins University in Baltimore, Maryland and Frederick L. Brancati, Professor of Medicine, also at Johns Hopkins.

The aim of the study was to gather evidence to objectively evaluate the current oral agents available for the treatment of diabetes.

According to the American Diabetes Association, type 2 diabetes, is the most common form of the disease and accounts for 90 to 95% of all new diagnosed cases of diabetes. It usually occurs in adults over 40 that tend to be overweight. Diabetics have difficulty in converting glucose (sugar) into energy because their cells do not make insulin (type 1) or are resistant to it (type 2).

As per the report, the research team wanted to review the known literature and assess the benefits and harms of oral agents in the treatment of adults with type 2 diabetes.

To conduct a comprehensive review, the team evaluated the majority of drug classes that are currently available and that include, second-generation sulfonylureas, biguanides, thiazolidinediones (TZDs), meglitinides, and alpha-glucosidase inhibitors.

The research team was able identify 216 controlled trials and cohort studies and 2 systematic reviews that specifically evaluated the benefits and adverse effects of oral diabetes drugs.

In the report, the research team stated that they were unable to make conclusions regarding the use of specific drugs and major clinical end points such as mortality. However, they were able to make distinctive assessments with respect to other clinical effects.

In their review, they found that oral agents such as the TZDs, Metformin, and Repaglinide, were able to control glucose levels as well as most sulfonylureas, but slightly better than products such as Nateglinide and alpha-glucosidase inhibitors.

With respect to cholesterol, they found that although the TZDs had a beneficial effect on HDLs (good cholesterol), they also unfortunately had a negative effect with respect to LDLs (bad cholesterol). The TZD's also posed a higher risk for heart failure as compared to the other diabetes drugs.

The research team found that Metformin effectively decreased LDL cholesterol in patients with diabetes an average of 0.26 mmol/L. The other oral drugs did not have any lowering effects on LDLs.

Perhaps the most interesting finding was that, with the exception of Metformin, most of the drugs increased the weight of diabetic patients anywhere from 1 to 5 kg (2.2 to 11 pounds). Metformin, however, was associated with a higher risk of gastrointestinal problems and lactic acidosis (in people with non-complicated diabetes).

With respect to adverse effects, the sulfonylureas and Repaglinide had a higher risk of inducing hypoglycemia (low glucose levels) as compared to the other oral agents.

In the AHRQ press release, Dr. Carolyn M. Clancy, Director of this agency stated that “as more people are diagnosed with type 2 diabetes and with the growing array of treatment choices, this is a landmark review. This summary of scientific evidence is not only an important tool for clinicians and patients seeking the most appropriate therapy, but it also points out in what areas we need more research to confront this disease.”

The researchers were also able to provide a comprehensive synopsis detailing the effectiveness, risks, and estimated costs for 10 diabetes drugs. They included, acarbose (Precose), glimepiride (Amaryl), glipizide (Glucotrol), glyburide (Micronase, DiaBeta, Glynase PresTab), metformin (Glucophage, Riomet, Fortamet), miglitol (Glyset), nateglinide (Starlix), pioglitazone (Actos), repaglinide (Prandin), and rosiglitazone (Avandia). For the full report please see: http://www.annals.org/cgi/content/full/0000605-200709180-00178v1

Sources:

Annals of Internal Medicine: http://www.annals.org/cgi/content/full/0000605-200709180-00178v1

Agency for Healthcare Research and Quality: http://www.ahrq.gov/news/press/pr2007/effdiabpr.htm

American Diabetes Association: http://www.diabetes.org/about-diabetes.jsp