Old vs. New

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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!

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