Type-2 diabetes 'better treated' by cheap drugs

Doubt has been cast on the value of thiazolidinediones in type-2 diabetes by US researchers.

A review of available literature showed older oral agents for blood glucose control in type-2 diabetes are as effective or superior to the newer, more expensive agents such as thiazolidinediones.

This follows recent study findings that showed the thiazolidinedione rosiglitazone could increase risk of MI by 43 per cent and death from MI by 64 per cent.

The review looked at 216 controlled trials, two systemic reviews and controlled on intermediate outcomes such as glycaemic control and effects on lipid levels.

HbA1c was lowered by around 1 percentage point by metformin, sulphonylureas, thiazolidinediones and repaglinide. A slightly weaker effect on glycaemic control was seen with nateglinide and alpha-glucosidase inhibitors.

Thiazolidinediones were the only drug class to boost HDL-cholesterol levels, but they also seem to be detrimental for LDL-cholesterol, with an average increase of 0.26mmol/l noted.

Metformin decreased LDL-cholesterol, and no other drugs appeared to affect lipid levels.

Current NICE guidelines on glucose control in type-2 diabetes recommend metformin as first-line treatment, followed by co-treatment with oral sulphonylureas. Thiazolidinediones are recommended third line if this combination proves ineffective.

A NICE review of these guidelines is expected early next year.

County Down GP Dr Colin Kenny, former chairman of the Primary Care Diabetes Society, said the findings of the review added further concern to the use of thiazolidinediones.

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