Old vs. New

New drugs for Type 2 diabetes are popping up all the time, it often seems. In recent years, drugs that work in entirely new ways in the body — constituting a new “class” of drugs — have been introduced to the market, as well as many others that are similar to — and therefore can compete with — existing drugs. But according to a recent study, all types of newer drugs have one thing in common: They are no better than older, cheaper diabetes drugs.

An article published last week in The New York Times examines the current state of diabetes drugs. In 2007, Americans spent $12.5 billion on diabetes drugs — twice what they spent just six years earlier. Part of this increase can be explained by a rise in the number of people with Type 2 diabetes, but most of it is due to more drugs and more expensive drugs being prescribed. And while these drugs may have useful applications, the rise in spending suggests that they are being treated not as exotic new additions to the diabetes drug arsenal, but as first-line treatments — even though evidence does not support using them this way. A report issued earlier this year by the Agency for Healthcare Research and Quality (AHRQ), a branch of the US Department of Health and Human Services, reviewed data from 166 studies on the benefits and risks of various oral drugs for Type 2 diabetes. It concluded what other organizations, such the American Diabetes Association, have also maintained: that the most effective drugs with the fewest side effects are older, cheaper ones.


The New York Times article also describes the recommended order of drug treatments for Type 2 diabetes, as outlined by the lead author of the AHRQ study. The first recommended treatment involves no drugs at all: lifestyle changes such as a better diet, more exercise, and quitting smoking. The second recommended treatment is to start, if necessary, taking metformin. This drug, usually taken twice daily, tends to cost around $36 for 100 pills. If necessary, the third step is to add a second cheap drug from the sulfonylurea family, such as glipizide or glimepiride. The American Diabetes Association recommends a similar course of treatment; its recommendations, however, also include basal (long-acting) insulin as an alternative to sulfonylureas when lifestyle changes and metformin are no longer enough to adequately control blood glucose levels. The most effective types of basal insulin, however, are not necessarily older and cheaper: insulin glargine (brand name Lantus) and insulin detemir (Levemir) tend to last longer in the body and lower blood glucose more consistently — with less of a “peak” of action — than the older NPH insulin (Humulin N, Novolin N).

What do you think — in your experience, have older, cheaper drugs been enough to control your diabetes? Is its failure to include insulin and other injected drugs in its analysis of older vs. newer treatments a major oversight of the AHRQ report? Have any newer, more expensive drugs proved indispensable to you? Leave a comment below!

  • Ruth Smith

    I have prediabetes according to my M.D. I get quarterly blood tests to check A1C among other things. So far, I have been able to keep my A1c at 6.5-6.7 with diet and exercise. Now my Dr. informs me that the ADA has reduced the A1c levels.

    I want to try the apple cider vinegar recipes to lower my A1c. The article suggests 20 grams of apple cider vinegar in 40 grams of water. This seems really strong to me. The recipes suggested by others were (1) 1 T vinegar to 1/2 glass water; (2)1 T vinegar in 1 cup water with stevia; and (3)apple cider vinegar in iced tea with lemon, lime or Stevia. The amount of 1 or 2 Tablespoons in water/tea seems more reasonable to me unless it takes 20 grams in 40 grams of water to produce the desired effect.

    Please advise.

  • lbala

    The newr ones like 30/70 and human acrapid work better than old insulins

  • jim snell

    THis article is interesting and curious. The last comment about 30/70 or is that 70/30 that it works better is vague and unspecific.

    The key issue on any drug/insulin that affects the insulin levels and speed of attack is the duration it acts and lasts.

    I could have murdered the nitwit who came up with pills and insulain lasting 10.5 hours to 12 hours.

    Those durations are great if you are thin and no need to lose weight. Get ready set and eat all day long on schedule – tight and look out for bouts of hypoglycemia.

    I finally booted out actos, starlix and 75/25 insulin and on simple metformin 3 times a day and 4 units of humolog lispro standard morning , lunch and night and my bg waveforms after 30 plus years of it being rail to rail are now stable, slowly moving and averaging 150-151. My last a1c was 6.9.

    I am fed up with all the mis-stupid information and bad ideas of how to take medicine. Having 10.5 hour duration and 12 hour duration medicine makes it impossible to adjust insulin/pills every 5 hours as needed.

    My life was a living hell of my 75/25 insulin running my life schedule, wasting test strips by the ton and watching my sugar run rail to rail every hour.